- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $8,709.64 / $15,135.61
| Facility | | $5,128.61 | $8,709.64 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $6,309.57 / $8,317.64 / $12,882.50
| Facility | 50 | $6,309.57 | $8,317.64 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $11,481.54 / $23,988.33
| Facility | | $4,365.16 | $11,481.54 | $23,988.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $575.44 / $4,073.80
| Facility | | $575.44 | $575.44 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $1,122.02 / $2,089.30
| Facility | | $741.31 | $1,122.02 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $19,952.62 / $25,703.96
| Facility | | $8,709.64 | $19,952.62 | $25,703.96 |