- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,703.19 / $6,853.00 / $18,755.75
| Facility | | $1,703.19 | $6,853.00 | $18,755.75 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $5,805.95 / $5,805.95 / $5,805.95
| Facility | 22 | $5,805.95 | $5,805.95 | $5,805.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,121.40 / $12,982.03 / $17,685.09
| Facility | | $11,121.40 | $12,982.03 | $17,685.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,369.76 / $6,853.00 / $15,216.29
| Facility | | $1,369.76 | $6,853.00 | $15,216.29 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $5,805.95 / $5,805.95 / $5,805.95
| Facility | 22 | $5,805.95 | $5,805.95 | $5,805.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,636.84 / $7,935.00 / $10,652.00
| Facility | | $4,636.84 | $7,935.00 | $10,652.00 |