- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $5,011.87 / $13,803.84
| Facility | | $1,023.29 | $5,011.87 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $6,456.54 / $14,125.38
| Facility | | $3,090.30 | $6,456.54 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $3,090.30 / $30,902.95
| Facility | | $1,071.52 | $3,090.30 | $30,902.95 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $1,258.93 / $1,258.93 / $1,258.93
| Facility | 22 | $1,258.93 | $1,258.93 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $5,623.41 / $12,882.50
| Facility | | $1,995.26 | $5,623.41 | $12,882.50 |