- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $542.89 / $7,838.38 / $8,763.29
| Facility | | $542.89 | $7,838.38 | $8,763.29 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $5,538.26 / $5,538.26 / $5,538.26
| Facility | 50 | $5,538.26 | $5,538.26 | $5,538.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,552.54 / $16,307.81 / $25,305.82
| Facility | | $4,552.54 | $16,307.81 | $25,305.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.33 / $713.33 / $960.09
| Facility | | $549.33 | $713.33 | $960.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $899.00 / $11,259.00 / $16,897.00
| Facility | | $899.00 | $11,259.00 | $16,897.00 |