- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $5,888.44 / $10,964.78
| Facility | | $1,445.44 | $5,888.44 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,454.71 / $6,760.83 / $14,125.38
| Facility | 50 | $2,454.71 | $6,760.83 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $1,621.81 / $1,905.46
| Facility | | $616.60 | $1,621.81 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $12,022.64 / $22,908.68
| Facility | | $6,165.95 | $12,022.64 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $5,623.41 / $9,772.37
| Facility | | $1,737.80 | $5,623.41 | $9,772.37 |