- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $5,370.32 / $17,378.01
| Facility | | $977.24 | $5,370.32 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $891.25 / $1,096.48
| Facility | | $891.25 | $891.25 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $1,445.44 / $1,445.44
| Facility | | $34.67 | $1,445.44 | $1,445.44 |
- 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
- $23,988.33 / $23,988.33 / $23,988.33
| Facility | | $23,988.33 | $23,988.33 | $23,988.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $2,884.03 / $10,471.29
| Facility | | $2,884.03 | $2,884.03 | $10,471.29 |