- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $1,288.25 / $1,995.26
| Facility | | $630.96 | $1,288.25 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $15,488.17 / $15,488.17 / $16,218.10
| Facility | 50 | $15,488.17 | $15,488.17 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $2,884.03 / $2,884.03
| Facility | | $2,884.03 | $2,884.03 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $7,244.36 / $7,244.36
| Facility | | $7,244.36 | $7,244.36 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $4,365.16 / $12,302.69
| Facility | | $977.24 | $4,365.16 | $12,302.69 |