- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,819.70 / $3,090.30
| Facility | | $1,202.26 | $1,819.70 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,621.81 / $8,317.64 / $14,791.08
| Facility | 50 | $1,621.81 | $8,317.64 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $6,025.60 / $8,317.64
| Facility | | $6,025.60 | $6,025.60 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $4,265.80 / $4,265.80
| Facility | | $4,265.80 | $4,265.80 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $3,981.07 / $11,748.98
| Facility | | $1,548.82 | $3,981.07 | $11,748.98 |