- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $153.55 / $394.62 / $5,043.35
| Facility | | $153.55 | $394.62 | $5,043.35 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,567.68 / $1,567.68 / $1,567.68
| Facility | 50 | $1,567.68 | $1,567.68 | $1,567.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $919.73 / $919.73 / $919.73
| Facility | | $919.73 | $919.73 | $919.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.96 / $4,359.05 / $5,704.55
| Facility | | $213.96 | $4,359.05 | $5,704.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,320.00 / $1,320.00 / $1,320.00
| Facility | | $1,320.00 | $1,320.00 | $1,320.00 |