- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $3,715.35 / $6,025.60
| Facility | | $2,290.87 | $3,715.35 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,715.35 / $7,943.28 / $21,877.62
| Facility | 50 | $3,715.35 | $7,943.28 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $6,918.31 / $18,197.01
| Facility | | $1,513.56 | $6,918.31 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,230.27 / $7,079.46
| Facility | | $575.44 | $1,230.27 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $6,918.31 / $15,488.17
| Facility | | $2,570.40 | $6,918.31 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $8,128.31 / $13,182.57
| Facility | | $1,230.27 | $8,128.31 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $7,244.36 / $18,197.01
| Facility | | $1,513.56 | $7,244.36 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $7,244.36 / $16,595.87
| Facility | | $2,570.40 | $7,244.36 | $16,595.87 |