- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $1,230.27 / $6,456.54
| Facility | | $204.17 | $1,230.27 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,715.35 / $9,332.54
| Facility | | $1,584.89 | $3,715.35 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.03 / $295.12 / $977.24
| Facility | | $123.03 | $295.12 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $295.12 / $295.12 / $295.12
| Facility | 22 | $295.12 | $295.12 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $1,071.52 / $3,467.37
| Facility | | $213.80 | $1,071.52 | $3,467.37 |