- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $5,011.87 / $12,022.64
| Facility | | $2,630.27 | $5,011.87 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,467.37 / $4,365.16 / $4,365.16
| Facility | 50 | $3,467.37 | $4,365.16 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $5,495.41 / $10,232.93
| Facility | | $2,630.27 | $5,495.41 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $707.95 / $1,659.59
| Facility | | $707.95 | $707.95 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $758.58 / $1,318.26
| Facility | | $524.81 | $758.58 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $10,964.78 / $16,982.44
| Facility | | $1,995.26 | $10,964.78 | $16,982.44 |