- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $4,786.30 / $12,022.64
| Facility | | $933.25 | $4,786.30 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,570.40 / $8,317.64 / $12,022.64
| Facility | 50 | $2,570.40 | $8,317.64 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $7,762.47 / $15,848.93
| Facility | | $2,754.23 | $7,762.47 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $2,290.87 / $5,888.44
| Facility | | $977.24 | $2,290.87 | $5,888.44 |
- 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 |