- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $2,137.96 / $5,754.40
| Facility | | $933.25 | $2,137.96 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,630.27 / $3,890.45 / $4,466.84
| Facility | 50 | $2,630.27 | $3,890.45 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $6,606.93 / $6,606.93
| Facility | | $6,606.93 | $6,606.93 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $5,495.41 / $12,882.50
| Facility | | $5,495.41 | $5,495.41 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $6,025.60 / $16,218.10
| Facility | | $1,174.90 | $6,025.60 | $16,218.10 |