- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $2,630.27 / $6,456.54
| Facility | | $891.25 | $2,630.27 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $2,754.23 / $3,801.89
| Facility | | $1,288.25 | $2,754.23 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $933.25 / $1,949.84
| Facility | | $457.09 | $933.25 | $1,949.84 |
- 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
- $54.95 / $56.23 / $4,897.79
| Facility | | $54.95 | $56.23 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $2,187.76 / $3,981.07
| Facility | | $1,023.29 | $2,187.76 | $3,981.07 |