- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $5,248.07 / $11,481.54
| Facility | | $616.60 | $5,248.07 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $7,244.36 / $14,791.08
| Facility | | $2,818.38 | $7,244.36 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $812.83 / $2,290.87
| Facility | | $416.87 | $812.83 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $537.03 / $537.03 / $537.03
| Facility | 22 | $537.03 | $537.03 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $4,365.16 / $10,471.29
| Facility | | $1,584.89 | $4,365.16 | $10,471.29 |