- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $2,691.53 / $6,456.54
| Facility | | $933.25 | $2,691.53 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,137.96 / $5,370.32 / $13,803.84
| Facility | 50 | $2,137.96 | $5,370.32 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $16,595.87 / $30,902.95
| Facility | | $8,912.51 | $16,595.87 | $30,902.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $16,595.87 / $16,595.87
| Facility | | $39.81 | $16,595.87 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $7,079.46 / $20,892.96
| Facility | | $1,202.26 | $7,079.46 | $20,892.96 |