- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $2,570.40 / $5,888.44
| Facility | | $851.14 | $2,570.40 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $5,623.41 / $6,918.31 / $6,918.31
| Facility | 50 | $5,623.41 | $6,918.31 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $5,888.44 / $8,912.51
| Facility | | $2,884.03 | $5,888.44 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $6,309.57 / $6,309.57
| Facility | | $39.81 | $6,309.57 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $3,467.37 / $8,511.38
| Facility | | $1,023.29 | $3,467.37 | $8,511.38 |