- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $5,495.41 / $5,495.41
| Facility | | $4,466.84 | $5,495.41 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,348.96 / $1,949.84
| Facility | | $1,230.27 | $1,348.96 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,819.70 / $2,041.74 / $2,951.21
| Facility | 50 | $1,819.70 | $2,041.74 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $489.78 / $933.25
| Facility | | $251.19 | $489.78 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $15,488.17 / $26,302.68
| Facility | | $3,715.35 | $15,488.17 | $26,302.68 |