- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,095.00 / $6,664.44 / $8,644.27
| Facility | | $2,095.00 | $6,664.44 | $8,644.27 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,696.94 / $6,860.12 / $12,467.70
| Facility | 50 | $3,696.94 | $6,860.12 | $12,467.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,735.95 / $15,811.44 / $25,351.22
| Facility | | $4,735.95 | $15,811.44 | $25,351.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $692.80 / $881.75 / $962.49
| Facility | | $692.80 | $881.75 | $962.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,028.00 / $15,131.00 / $16,269.00
| Facility | | $9,028.00 | $15,131.00 | $16,269.00 |