- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $4,168.69 / $20,892.96
| Facility | | $575.44 | $4,168.69 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $17,782.79 / $41,686.94
| Facility | | $6,918.31 | $17,782.79 | $41,686.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $17,782.79 / $52,480.75
| Facility | | $707.95 | $17,782.79 | $52,480.75 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $588.84 / $588.84 / $588.84
| Facility | 22 | $588.84 | $588.84 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $1,905.46 / $30,199.52
| Facility | | $323.59 | $1,905.46 | $30,199.52 |