- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $7,585.78 / $22,908.68
| Facility | | $1,445.44 | $7,585.78 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $16,595.87 / $53,703.18
| Facility | | $8,317.64 | $16,595.87 | $53,703.18 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $2,454.71 / $2,454.71 / $2,454.71
| Facility | 22 | $2,454.71 | $2,454.71 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $12,022.64 / $22,908.68
| Facility | | $6,165.95 | $12,022.64 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,791.08 / $30,902.95 / $91,201.08
| Facility | | $14,791.08 | $30,902.95 | $91,201.08 |