- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $4,897.79 / $12,589.25
| Facility | | $724.44 | $4,897.79 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,258.93 / $6,025.60 / $16,982.44
| Facility | 50 | $1,258.93 | $6,025.60 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $8,511.38 / $18,620.87
| Facility | | $3,548.13 | $8,511.38 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $1,949.84 / $14,454.40
| Facility | | $794.33 | $1,949.84 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $954.99 / $954.99 / $954.99
| Facility | 22 | $954.99 | $954.99 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $5,754.40 / $14,125.38
| Facility | | $1,905.46 | $5,754.40 | $14,125.38 |