- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $4,265.80 / $10,964.78
| Facility | | $218.78 | $4,265.80 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,691.53 / $2,691.53 / $2,691.53
| Facility | 50 | $2,691.53 | $2,691.53 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $1,202.26 / $2,238.72
| Facility | | $512.86 | $1,202.26 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.88 / $234.42 / $363.08
| Facility | | $154.88 | $234.42 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $3,890.45 / $7,762.47
| Facility | | $1,122.02 | $3,890.45 | $7,762.47 |