- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $1,698.24 / $4,365.16
| Facility | | $524.81 | $1,698.24 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $4,365.16 / $6,760.83
| Facility | | $2,570.40 | $4,365.16 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $3,467.37 / $3,467.37
| Facility | | $309.03 | $3,467.37 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $724.44 / $2,754.23
| Facility | | $616.60 | $724.44 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $741.31 / $741.31 / $741.31
| Facility | 22 | $741.31 | $741.31 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $2,630.27 / $6,606.93
| Facility | | $831.76 | $2,630.27 | $6,606.93 |