- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $3,981.07 / $13,182.57
| Facility | | $346.74 | $3,981.07 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $1,737.80 / $4,570.88
| Facility | | $537.03 | $1,737.80 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $562.34 / $1,096.48
| Facility | | $371.54 | $562.34 | $1,096.48 |
- 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
- $263.03 / $371.54 / $588.84
| Facility | | $263.03 | $371.54 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $6,309.57 / $10,000.00
| Facility | | $616.60 | $6,309.57 | $10,000.00 |