- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $805.04 / $805.04 / $805.04
| Facility | | $805.04 | $805.04 | $805.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,515.23 / $6,238.56 / $12,483.38
| Facility | | $3,515.23 | $6,238.56 | $12,483.38 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $7,268.16 / $11,027.38 / $19,335.54
| Facility | 50 | $7,268.16 | $11,027.38 | $19,335.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,927.94 / $2,734.06 / $6,577.16
| Facility | | $1,927.94 | $2,734.06 | $6,577.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,567.28 / $2,499.59 / $5,178.85
| Facility | | $1,567.28 | $2,499.59 | $5,178.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,069.94 / $1,488.66 / $3,378.00
| Facility | | $1,069.94 | $1,488.66 | $3,378.00 |
- 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 |