- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $3,019.95 / $9,549.93
| Facility | | $575.44 | $3,019.95 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,148.15 / $5,128.61 / $12,302.69
| Facility | 50 | $1,148.15 | $5,128.61 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $4,570.88 / $13,489.63
| Facility | | $1,621.81 | $4,570.88 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $1,698.24 / $4,786.30
| Facility | | $933.25 | $1,698.24 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $4,265.80 / $9,772.37
| Facility | | $1,584.89 | $4,265.80 | $9,772.37 |