- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $4,466.84 / $11,748.98
| Facility | | $933.25 | $4,466.84 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,513.56 / $6,165.95 / $12,302.69
| Facility | 50 | $1,513.56 | $6,165.95 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $6,165.95 / $14,125.38
| Facility | | $2,818.38 | $6,165.95 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $2,089.30 / $5,754.40
| Facility | | $977.24 | $2,089.30 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $5,623.41 / $12,589.25
| Facility | | $1,995.26 | $5,623.41 | $12,589.25 |