- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,202.26 / $3,548.13
| Facility | | $1,202.26 | $1,202.26 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,258.93 / $1,513.56
| Facility | | $1,258.93 | $1,258.93 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,041.74 / $4,168.69
| Facility | | $2,041.74 | $2,041.74 | $4,168.69 |
- 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
- $36,307.81 / $47,863.01 / $169,824.37
| Facility | | $36,307.81 | $47,863.01 | $169,824.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34,673.69 / $34,673.69 / $91,201.08
| Facility | | $34,673.69 | $34,673.69 | $91,201.08 |