- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.74 / $2,743.42 / $4,658.56
| Facility | | $162.74 | $2,743.42 | $4,658.56 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $8,064.42 / $8,064.42 / $8,064.42
| Facility | 50 | $8,064.42 | $8,064.42 | $8,064.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $163.95 / $181.87 / $198.15
| Facility | | $163.95 | $181.87 | $198.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.43 / $177.43 / $177.43
| Facility | | $177.43 | $177.43 | $177.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,983.60 / $5,713.61 / $8,763.14
| Facility | | $1,983.60 | $5,713.61 | $8,763.14 |