- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79.43 / $2,187.76 / $7,943.28
| Facility | | $79.43 | $2,187.76 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $288.40 / $851.14 / $2,570.40
| Facility | 50 | $288.40 | $851.14 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $3,630.78 / $8,709.64
| Facility | | $1,445.44 | $3,630.78 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $52.48 / $251.19 / $1,288.25
| Facility | | $52.48 | $251.19 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $1,071.52 / $3,467.37
| Facility | | $204.17 | $1,071.52 | $3,467.37 |