- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $10,232.93 / $19,952.62
| Facility | | $977.24 | $10,232.93 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $5,011.87 / $10,471.29
| Facility | | $2,137.96 | $5,011.87 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $562.34 / $1,096.48
| Facility | | $34.67 | $562.34 | $1,096.48 |
- 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
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $870.96 / $1,023.29
| Professional | | $870.96 | $870.96 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $851.14 / $1,348.96
| Facility | | $630.96 | $851.14 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $12,589.25 / $23,988.33
| Facility | | $1,230.27 | $12,589.25 | $23,988.33 |