- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $6,918.31 / $8,128.31
| Facility | | $933.25 | $6,918.31 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $6,918.31 / $8,317.64 / $10,232.93
| Facility | 50 | $6,918.31 | $8,317.64 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $977.24 / $1,479.11
| Facility | | $977.24 | $977.24 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $4,897.79 / $8,128.31
| Facility | | $933.25 | $4,897.79 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $6,918.31 / $8,317.64 / $10,232.93
| Facility | 50 | $6,918.31 | $8,317.64 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $6,309.57 / $10,471.29
| Facility | | $2,951.21 | $6,309.57 | $10,471.29 |