- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $4,786.30 / $11,481.54
| Facility | | $870.96 | $4,786.30 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,290.87 / $5,128.61 / $21,379.62
| Facility | 50 | $2,290.87 | $5,128.61 | $21,379.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $8,511.38 / $15,135.61
| Facility | | $3,235.94 | $8,511.38 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $562.34 / $2,511.89
| Facility | | $208.93 | $562.34 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $1,148.15 / $3,630.78
| Facility | | $234.42 | $1,148.15 | $3,630.78 |