- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $1,380.38 / $7,762.47
| Facility | | $588.84 | $1,380.38 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $8,128.31 / $12,882.50
| Facility | | $2,344.23 | $8,128.31 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $724.44 / $3,235.94
| Facility | | $724.44 | $724.44 | $3,235.94 |
- 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
- $416.87 / $645.65 / $1,122.02
| Facility | | $416.87 | $645.65 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $6,025.60 / $26,302.68
| Facility | | $645.65 | $6,025.60 | $26,302.68 |