- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $4,897.79 / $11,481.54
| Facility | | $416.87 | $4,897.79 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $13,803.84 / $19,054.61
| Facility | | $2,344.23 | $13,803.84 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $354.81 / $398.11
| Facility | | $338.84 | $354.81 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $602.56 / $2,511.89
| Facility | | $537.03 | $602.56 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $724.44 / $724.44 / $724.44
| Facility | 22 | $724.44 | $724.44 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $6,025.60 / $10,715.19
| Facility | | $2,137.96 | $6,025.60 | $10,715.19 |