- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,416.59 / $5,131.07 / $11,872.20
| Facility | | $4,416.59 | $5,131.07 | $11,872.20 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $7,402.37 / $7,402.37 / $7,402.37
| Facility | 50 | $7,402.37 | $7,402.37 | $7,402.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $349.04 / $386.48 / $421.08
| Facility | | $349.04 | $386.48 | $421.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $373.54 / $373.54 / $373.54
| Facility | | $373.54 | $373.54 | $373.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,859.33 / $6,301.33 / $15,755.99
| Facility | | $3,859.33 | $6,301.33 | $15,755.99 |