- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.97 / $1,023.29 / $2,570.40
| Facility | | $181.97 | $1,023.29 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $758.58 / $758.58 / $4,677.35
| Facility | 50 | $758.58 | $758.58 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $1,698.24 / $1,862.09
| Facility | | $1,698.24 | $1,698.24 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $1,659.59 / $3,467.37
| Facility | | $1,659.59 | $1,659.59 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $2,691.53 / $6,760.83
| Facility | | $724.44 | $2,691.53 | $6,760.83 |