- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $4,570.88 / $10,715.19
| Facility | | $851.14 | $4,570.88 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,090.30 / $7,244.36 / $12,882.50
| Facility | 50 | $3,090.30 | $7,244.36 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $6,309.57 / $12,302.69
| Facility | | $2,454.71 | $6,309.57 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $1,318.26 / $3,981.07
| Facility | | $602.56 | $1,318.26 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $4,168.69 / $9,549.93
| Facility | | $1,445.44 | $4,168.69 | $9,549.93 |