- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $1,905.46 / $8,511.38
| Facility | | $724.44 | $1,905.46 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $8,511.38 / $8,912.51 / $8,912.51
| Facility | 50 | $8,511.38 | $8,912.51 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $977.24 / $2,951.21
| Facility | | $933.25 | $977.24 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $12,589.25 / $12,589.25 / $12,589.25
| Facility | 50 | $12,589.25 | $12,589.25 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $8,912.51 / $8,912.51
| Facility | | $7,943.28 | $8,912.51 | $8,912.51 |