- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,161.85 / $8,673.37 / $8,871.71
| Facility | | $4,161.85 | $8,673.37 | $8,871.71 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $5,545.06 / $5,545.06 / $5,545.06
| Facility | 50 | $5,545.06 | $5,545.06 | $5,545.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $469.78 / $511.03 / $556.78
| Facility | | $469.78 | $511.03 | $556.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.18 / $505.18 / $505.18
| Facility | | $505.18 | $505.18 | $505.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,703.20 / $4,319.60 / $9,805.96
| Facility | | $3,703.20 | $4,319.60 | $9,805.96 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,782.08 / $3,782.08 / $3,782.08
| Facility | 50 | $3,782.08 | $3,782.08 | $3,782.08 |