- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,235.49 / $1,235.49 / $1,235.49
| Facility | | $1,235.49 | $1,235.49 | $1,235.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,511.39 / $7,590.79 / $14,098.13
| Facility | | $4,511.39 | $7,590.79 | $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
- $3,130.70 / $4,439.71 / $10,680.33
| Facility | | $3,130.70 | $4,439.71 | $10,680.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,545.03 / $4,058.96 / $8,409.70
| Facility | | $2,545.03 | $4,058.96 | $8,409.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,713.08 / $2,239.87 / $3,500.00
| Facility | | $1,713.08 | $2,239.87 | $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 |