- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $812.83 / $812.83
| Facility | | $812.83 | $812.83 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $7,413.10 / $18,197.01
| Facility | | $4,168.69 | $7,413.10 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $7,413.10 / $13,182.57 / $33,884.42
| Facility | 50 | $7,413.10 | $13,182.57 | $33,884.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,884.03 / $6,918.31
| Facility | | $2,041.74 | $2,884.03 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,754.23 / $5,370.32
| Facility | | $2,238.72 | $2,754.23 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $1,584.89 / $3,467.37
| Facility | | $891.25 | $1,584.89 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,467.37 / $8,511.38
| Facility | | $1,584.89 | $3,467.37 | $8,511.38 |