- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $5,248.07 / $8,709.64
| Facility | | $870.96 | $5,248.07 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $6,165.95 / $6,165.95 / $9,120.11
| Facility | 50 | $6,165.95 | $6,165.95 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $794.33 / $1,202.26
| Facility | | $588.84 | $794.33 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $9,549.93 / $14,454.40
| Facility | | $2,884.03 | $9,549.93 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $8,709.64 / $19,498.45
| Facility | | $8,709.64 | $8,709.64 | $19,498.45 |