- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $6,606.93 / $14,125.38
| Facility | | $2,691.53 | $6,606.93 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $2,818.38 / $2,818.38 / $2,818.38
| Facility | 22 | $2,818.38 | $2,818.38 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $10,715.19 / $11,220.18
| Facility | | $6,760.83 | $10,715.19 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $6,760.83 / $18,620.87
| Facility | | $912.01 | $6,760.83 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,238.72 / $6,918.31
| Facility | | $1,548.82 | $2,238.72 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $6,918.31 / $11,748.98
| Facility | | $2,818.38 | $6,918.31 | $11,748.98 |