- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $2,691.53 / $8,912.51
| Facility | | $489.78 | $2,691.53 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,691.53 / $3,019.95 / $12,022.64
| Facility | 50 | $2,691.53 | $3,019.95 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $4,786.30 / $12,882.50
| Facility | | $2,570.40 | $4,786.30 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $2,754.23 / $7,585.78
| Facility | | $34.67 | $2,754.23 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $1,202.26 / $3,630.78
| Facility | | $295.12 | $1,202.26 | $3,630.78 |