- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,235.94 / $13,803.84
| Facility | | $851.14 | $3,235.94 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $741.31 / $1,621.81 / $7,943.28
| Facility | 50 | $741.31 | $1,621.81 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $2,344.23 / $16,218.10
| Facility | | $724.44 | $2,344.23 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $13,803.84 / $15,848.93
| Facility | | $7,413.10 | $13,803.84 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $2,884.03 / $16,218.10
| Facility | | $588.84 | $2,884.03 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,801.89 / $6,918.31
| Facility | | $2,454.71 | $3,801.89 | $6,918.31 |