- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.61 / $1,174.61 / $1,174.61
| Facility | | $1,174.61 | $1,174.61 | $1,174.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,166.47 / $7,242.30 / $13,020.23
| Facility | | $4,166.47 | $7,242.30 | $13,020.23 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $7,341.39 / $11,138.50 / $19,530.37
| Facility | 50 | $7,341.39 | $11,138.50 | $19,530.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,908.34 / $4,124.38 / $9,921.76
| Facility | | $2,908.34 | $4,124.38 | $9,921.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,364.27 / $3,770.68 / $7,812.41
| Facility | | $2,364.27 | $3,770.68 | $7,812.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,430.05 / $2,092.48 / $3,500.00
| Facility | | $1,430.05 | $2,092.48 | $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 |