- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $2,818.38 / $8,511.38
| Facility | | $851.14 | $2,818.38 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,128.31 / $10,715.19 / $13,182.57
| Facility | | $8,128.31 | $10,715.19 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,659.59 / $1,995.26
| Facility | | $1,202.26 | $1,659.59 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $1,995.26 / $2,238.72
| Facility | | $34.67 | $1,995.26 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $2,691.53 / $2,691.53 / $2,691.53
| Facility | 22 | $2,691.53 | $2,691.53 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $4,466.84 / $30,199.52
| Facility | | $602.56 | $4,466.84 | $30,199.52 |