- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $3,890.45 / $7,762.47
| Facility | | $1,096.48 | $3,890.45 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,290.87 / $3,019.95 / $12,589.25
| Facility | 50 | $2,290.87 | $3,019.95 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $10,471.29 / $16,982.44
| Facility | | $6,760.83 | $10,471.29 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $3,019.95 / $8,709.64
| Facility | | $724.44 | $3,019.95 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $4,265.80 / $8,317.64
| Facility | | $1,230.27 | $4,265.80 | $8,317.64 |