- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $741.31 / $2,290.87
| Facility | | $676.08 | $741.31 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $6,165.95 / $6,165.95 / $6,165.95
| Facility | 50 | $6,165.95 | $6,165.95 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $758.58 / $912.01
| Facility | | $758.58 | $758.58 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,202.26 / $2,290.87
| Facility | | $1,202.26 | $1,202.26 | $2,290.87 |
- 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
- $5,128.61 / $9,549.93 / $10,964.78
| Facility | | $5,128.61 | $9,549.93 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $18,197.01 / $18,197.01 / $19,054.61
| Facility | 50 | $18,197.01 | $18,197.01 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $2,884.03 / $10,964.78
| Facility | | $2,884.03 | $2,884.03 | $10,964.78 |