- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $6,165.95 / $10,964.78
| Facility | | $2,137.96 | $6,165.95 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,951.21 / $10,964.78 / $10,964.78
| Facility | 50 | $2,951.21 | $10,964.78 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $97.72 / $114.82 / $114.82
| Facility | | $97.72 | $114.82 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $6,165.95 / $11,481.54
| Facility | | $1,258.93 | $6,165.95 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,951.21 / $10,964.78 / $10,964.78
| Facility | 50 | $2,951.21 | $10,964.78 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $7,413.10 / $12,882.50
| Facility | | $3,981.07 | $7,413.10 | $12,882.50 |