- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,128.97 / $1,128.97 / $1,128.97
| Facility | | $1,128.97 | $1,128.97 | $1,128.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,511.39 / $7,386.49 / $14,098.13
| Facility | | $4,511.39 | $7,386.49 | $14,098.13 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $7,949.16 / $12,060.61 / $21,147.21
| Facility | 50 | $7,949.16 | $12,060.61 | $21,147.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,851.91 / $4,044.36 / $9,729.25
| Facility | | $2,851.91 | $4,044.36 | $9,729.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,318.39 / $3,697.51 / $7,660.83
| Facility | | $2,318.39 | $3,697.51 | $7,660.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,558.56 / $2,037.44 / $3,500.00
| Facility | | $1,558.56 | $2,037.44 | $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 |