- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $4,897.79 / $14,125.38
| Facility | | $676.08 | $4,897.79 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $13,803.84 / $19,054.61
| Facility | | $3,630.78 | $13,803.84 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $630.96 / $707.95
| Facility | | $602.56 | $630.96 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $1,023.29 / $1,318.26
| Facility | | $660.69 | $1,023.29 | $1,318.26 |
- 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
- $3,235.94 / $7,762.47 / $10,964.78
| Facility | | $3,235.94 | $7,762.47 | $10,964.78 |