- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $2,041.74 / $3,019.95
| Facility | | $1,230.27 | $2,041.74 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,737.80 / $3,467.37 / $3,890.45
| Facility | 50 | $1,737.80 | $3,467.37 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,982.44 / $16,982.44 / $23,442.29
| Facility | | $16,982.44 | $16,982.44 | $23,442.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $5,888.44 / $5,888.44
| Facility | | $5,888.44 | $5,888.44 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $5,495.41 / $18,197.01
| Facility | | $2,089.30 | $5,495.41 | $18,197.01 |