- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,003.47 / $1,494.00 / $3,188.94
| Facility | | $1,003.47 | $1,494.00 | $3,188.94 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,863.40 / $2,118.50 / $2,118.50
| Facility | 50 | $1,863.40 | $2,118.50 | $2,118.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,955.73 / $8,955.73 / $10,746.88
| Facility | | $8,955.73 | $8,955.73 | $10,746.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,875.75 / $5,875.75 / $5,875.75
| Facility | | $5,875.75 | $5,875.75 | $5,875.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,000.00 / $4,334.00 / $8,676.00
| Facility | | $2,000.00 | $4,334.00 | $8,676.00 |