- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $4,897.79 / $11,220.18
| Facility | | $288.40 | $4,897.79 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $8,317.64 / $10,471.29
| Facility | | $2,344.23 | $8,317.64 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $269.15 / $302.00
| Facility | | $257.04 | $269.15 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $436.52 / $588.84
| Facility | | $281.84 | $436.52 | $588.84 |
- 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
- $1,412.54 / $3,715.35 / $6,456.54
| Facility | | $1,412.54 | $3,715.35 | $6,456.54 |