- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $6,025.60 / $21,877.62
| Facility | | $1,047.13 | $6,025.60 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $23,442.29 / $42,657.95
| Facility | | $398.11 | $23,442.29 | $42,657.95 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $1,737.80 / $1,737.80 / $1,737.80
| Facility | 22 | $1,737.80 | $1,737.80 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $12,022.64 / $22,908.68
| Facility | | $6,165.95 | $12,022.64 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $7,585.78 / $12,022.64
| Facility | | $2,630.27 | $7,585.78 | $12,022.64 |