- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $5,370.32 / $11,748.98
| Facility | | $1,862.09 | $5,370.32 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $13,489.63 / $28,183.83
| Facility | | $4,677.35 | $13,489.63 | $28,183.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $8,912.51 / $27,542.29
| Facility | | $549.54 | $8,912.51 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $8,709.64 / $8,709.64 / $8,709.64
| Facility | 22 | $8,709.64 | $8,709.64 | $8,709.64 |
- 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 |