- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $812.83 / $812.83
| Facility | | $812.83 | $812.83 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $2,238.72 / $6,606.93
| Facility | | $977.24 | $2,238.72 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,445.44 / $2,630.27 / $6,606.93
| Facility | 50 | $1,445.44 | $2,630.27 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,691.53 / $6,456.54
| Facility | | $1,905.46 | $2,691.53 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $1,621.81 / $1,621.81 / $1,621.81
| Facility | 22 | $1,621.81 | $1,621.81 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $138.04 / $138.04 / $138.04
| Facility | AS | $138.04 | $138.04 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,570.40 / $5,011.87
| Facility | | $2,089.30 | $2,570.40 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,659.59 / $3,981.07
| Facility | | $1,122.02 | $1,659.59 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,467.37 / $8,511.38
| Facility | | $1,584.89 | $3,467.37 | $8,511.38 |