- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $5,495.41 / $5,495.41
| Facility | | $4,466.84 | $5,495.41 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $5,128.61 / $6,165.95
| Facility | | $4,570.88 | $5,128.61 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $7,079.46 / $7,762.47 / $9,332.54
| Facility | 50 | $7,079.46 | $7,762.47 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $2,630.27 / $4,265.80
| Facility | | $1,445.44 | $2,630.27 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $15,488.17 / $26,302.68
| Facility | | $3,715.35 | $15,488.17 | $26,302.68 |