- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $1,230.27 / $2,238.72
| Facility | | $616.60 | $1,230.27 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $478.63 / $478.63 / $2,570.40
| Facility | 50 | $478.63 | $478.63 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,230.27 / $1,698.24
| Facility | | $1,047.13 | $1,230.27 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,584.89 / $1,862.09 / $2,511.89
| Facility | 50 | $1,584.89 | $1,862.09 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $3,630.78 / $5,370.32
| Facility | | $1,122.02 | $3,630.78 | $5,370.32 |