- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $4,168.69 / $10,471.29
| Facility | | $645.65 | $4,168.69 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $2,691.53 / $2,691.53 / $6,165.95
| Facility | 22 | $2,691.53 | $2,691.53 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $4,897.79 / $10,471.29
| Facility | | $1,621.81 | $4,897.79 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $758.58 / $2,137.96
| Facility | | $371.54 | $758.58 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $549.54 / $549.54 / $549.54
| Facility | 22 | $549.54 | $549.54 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $2,630.27 / $6,309.57
| Facility | | $660.69 | $2,630.27 | $6,309.57 |