- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $4,897.79 / $11,220.18
| Facility | | $1,023.29 | $4,897.79 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,187.76 / $5,495.41 / $11,220.18
| Facility | 50 | $2,187.76 | $5,495.41 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $7,413.10 / $14,791.08
| Facility | | $2,630.27 | $7,413.10 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $1,348.96 / $3,981.07
| Facility | | $691.83 | $1,348.96 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $4,168.69 / $9,549.93
| Facility | | $1,445.44 | $4,168.69 | $9,549.93 |