- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $4,677.35 / $11,220.18
| Facility | | $1,819.70 | $4,677.35 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $12,022.64 / $22,387.21
| Facility | | $4,265.80 | $12,022.64 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $5,754.40 / $16,218.10
| Facility | | $323.59 | $5,754.40 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $3,981.07 / $3,981.07 / $3,981.07
| Facility | 22 | $3,981.07 | $3,981.07 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,162.28 / $10,232.93
| Facility | | $851.14 | $3,162.28 | $10,232.93 |