- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $6,025.60 / $15,135.61
| Facility | | $1,698.24 | $6,025.60 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $10,232.93 / $20,417.38
| Facility | | $3,890.45 | $10,232.93 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,786.30 / $15,848.93
| Facility | | $2,238.72 | $4,786.30 | $15,848.93 |
- 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
- $3,019.95 / $8,912.51 / $20,417.38
| Facility | | $3,019.95 | $8,912.51 | $20,417.38 |