- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,834.35 / $7,881.00 / $12,096.23
| Facility | | $1,834.35 | $7,881.00 | $12,096.23 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $7,085.70 / $7,085.70 / $7,085.70
| Facility | 22 | $7,085.70 | $7,085.70 | $7,085.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,084.00 / $4,426.00 / $19,117.00
| Facility | | $2,084.00 | $4,426.00 | $19,117.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,250.84 / $1,501.02 / $1,857.84
| Facility | | $1,250.84 | $1,501.02 | $1,857.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,571.00 / $21,571.00 / $21,571.00
| Facility | | $21,571.00 | $21,571.00 | $21,571.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.80 / $0.80 / $0.80
| Facility | | $0.80 | $0.80 | $0.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,879.00 / $5,726.00 / $9,483.00
| Facility | | $3,879.00 | $5,726.00 | $9,483.00 |