- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $2,041.74 / $4,897.79
| Facility | | $758.58 | $2,041.74 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $2,630.27 / $3,630.78
| Facility | | $1,445.44 | $2,630.27 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $1,380.38 / $1,380.38
| Facility | | $234.42 | $1,380.38 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $812.83 / $1,258.93
| Facility | | $457.09 | $812.83 | $1,258.93 |
- 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
- $467.74 / $1,412.54 / $4,168.69
| Facility | | $467.74 | $1,412.54 | $4,168.69 |