- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $2,344.23 / $6,606.93
| Facility | | $549.54 | $2,344.23 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $5,248.07 / $5,248.07 / $5,248.07
| Facility | 50 | $5,248.07 | $5,248.07 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $5,754.40 / $9,332.54
| Facility | | $3,715.35 | $5,754.40 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $812.83 / $5,754.40
| Facility | | $436.52 | $812.83 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $3,311.31 / $6,025.60
| Facility | | $891.25 | $3,311.31 | $6,025.60 |