- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,265.26 / $6,265.26 / $6,265.26
| Facility | | $6,265.26 | $6,265.26 | $6,265.26 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $7,972.81 / $29,856.47 / $51,248.70
| Facility | 50 | $7,972.81 | $29,856.47 | $51,248.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47,000.00 / $81,499.99 / $94,999.99
| Facility | | $47,000.00 | $81,499.99 | $94,999.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,726.20 / $1,726.20 / $1,726.20
| Facility | | $1,726.20 | $1,726.20 | $1,726.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $856.13 / $1,909.70 / $2,065.11
| Facility | | $856.13 | $1,909.70 | $2,065.11 |