- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $1,819.70 / $5,495.41
| Facility | | $724.44 | $1,819.70 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,819.70 / $8,709.64 / $8,709.64
| Facility | 50 | $1,819.70 | $8,709.64 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,398.83 / $4,365.16
| Facility | | $1,513.56 | $2,398.83 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $954.99 / $1,122.02
| Facility | | $676.08 | $954.99 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,288.25 / $1,659.59
| Facility | | $1,288.25 | $1,288.25 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $4,677.35 / $16,595.87
| Facility | | $851.14 | $4,677.35 | $16,595.87 |