- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,241.22 / $10,563.53 / $20,928.72
| Facility | | $4,241.22 | $10,563.53 | $20,928.72 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $5,473.67 / $10,574.79 / $12,032.41
| Facility | 50 | $5,473.67 | $10,574.79 | $12,032.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,187.86 / $8,386.12 / $15,742.91
| Facility | | $6,187.86 | $8,386.12 | $15,742.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $670.77 / $1,309.57 / $8,632.00
| Facility | | $670.77 | $1,309.57 | $8,632.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,233.18 / $1,570.69 / $2,865.45
| Facility | | $1,233.18 | $1,570.69 | $2,865.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $7,441.00 / $8,816.00
| Facility | | $5,341.00 | $7,441.00 | $8,816.00 |