- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,428.80 / $5,757.00 / $11,016.21
| Facility | | $1,428.80 | $5,757.00 | $11,016.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,402.83 / $12,143.24 / $16,542.43
| Facility | | $10,402.83 | $12,143.24 | $16,542.43 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $5,643.94 / $7,659.41 / $10,787.11
| Facility | 50 | $5,643.94 | $7,659.41 | $10,787.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,296.26 / $5,757.00 / $9,904.19
| Facility | | $1,296.26 | $5,757.00 | $9,904.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,069.00 / $8,847.00 / $10,652.00
| Facility | | $4,069.00 | $8,847.00 | $10,652.00 |