- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $4,786.30 / $11,748.98
| Facility | | $707.95 | $4,786.30 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $870.96 / $5,495.41 / $14,791.08
| Facility | 50 | $870.96 | $5,495.41 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $7,585.78 / $14,791.08
| Facility | | $2,691.53 | $7,585.78 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $1,380.38 / $3,311.31
| Facility | | $645.65 | $1,380.38 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $4,365.16 / $10,232.93
| Facility | | $1,584.89 | $4,365.16 | $10,232.93 |