- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,113.04 / $1,113.04 / $1,113.04
| Facility | | $1,113.04 | $1,113.04 | $1,113.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $838.25 / $2,110.42 / $8,400.65
| Facility | | $838.25 | $2,110.42 | $8,400.65 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,432.44 / $2,173.33 / $3,810.74
| Facility | 50 | $1,432.44 | $2,173.33 | $3,810.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,457.73 / $3,485.36 / $8,384.51
| Facility | | $2,457.73 | $3,485.36 | $8,384.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,997.95 / $3,186.46 / $6,601.98
| Facility | | $1,997.95 | $3,186.46 | $6,601.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,676.33 / $2,030.87 / $3,500.00
| Facility | | $1,676.33 | $2,030.87 | $3,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,751.00 / $3,500.00 / $8,152.00
| Facility | | $1,751.00 | $3,500.00 | $8,152.00 |