- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,513.56 / $2,454.71
| Facility | | $758.58 | $1,513.56 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,621.81 / $1,621.81 / $1,621.81
| Facility | 50 | $1,621.81 | $1,621.81 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,137.96 / $2,951.21
| Facility | | $2,137.96 | $2,137.96 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $2,344.23 / $2,344.23
| Facility | | $2,344.23 | $2,344.23 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $2,041.74 / $6,760.83
| Facility | | $977.24 | $2,041.74 | $6,760.83 |