- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $4,897.79 / $10,715.19
| Facility | | $1,047.13 | $4,897.79 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,445.44 / $6,165.95 / $19,054.61
| Facility | 50 | $1,445.44 | $6,165.95 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $1,548.82 / $1,819.70
| Facility | | $616.60 | $1,548.82 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $1,445.44 / $1,445.44 / $1,445.44
| Facility | 22 | $1,445.44 | $1,445.44 | $1,445.44 |
- 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
- $2,630.27 / $7,585.78 / $12,022.64
| Facility | | $2,630.27 | $7,585.78 | $12,022.64 |