- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $3,715.35 / $10,471.29
| Facility | | $812.83 | $3,715.35 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $6,456.54 / $14,125.38
| Facility | | $2,344.23 | $6,456.54 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $1,659.59 / $7,762.47
| Facility | | $602.56 | $1,659.59 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $870.96 / $870.96 / $870.96
| Facility | 22 | $870.96 | $870.96 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $4,265.80 / $10,715.19
| Facility | | $1,047.13 | $4,265.80 | $10,715.19 |