- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $5,754.40 / $11,481.54
| Facility | | $1,047.13 | $5,754.40 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $457.09 / $2,041.74
| Facility | | $323.59 | $457.09 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $1,318.26 / $1,318.26 / $1,318.26
| Facility | 22 | $1,318.26 | $1,318.26 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $11,748.98 / $22,908.68
| Facility | | $5,495.41 | $11,748.98 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $7,585.78 / $11,748.98
| Facility | | $2,290.87 | $7,585.78 | $11,748.98 |