- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $3,090.30 / $5,623.41
| Facility | | $1,258.93 | $3,090.30 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $524.81 / $4,168.69 / $8,128.31
| Facility | 50 | $524.81 | $4,168.69 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $1,348.96 / $1,995.26
| Facility | | $416.87 | $1,348.96 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $645.65 / $5,011.87
| Facility | | $354.81 | $645.65 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $3,311.31 / $5,370.32
| Facility | | $2,290.87 | $3,311.31 | $5,370.32 |