- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,419.30 / $4,112.00 / $5,756.00
| Facility | | $1,419.30 | $4,112.00 | $5,756.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,142.11 / $13,077.57 / $17,718.03
| Facility | | $11,142.11 | $13,077.57 | $17,718.03 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $7,042.18 / $9,993.65 / $11,553.70
| Facility | 50 | $7,042.18 | $9,993.65 | $11,553.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,260.36 / $4,112.00 / $5,756.00
| Facility | | $1,260.36 | $4,112.00 | $5,756.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,635.00 / $11,152.00 / $20,268.00
| Facility | | $4,635.00 | $11,152.00 | $20,268.00 |