- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,298.70 / $1,298.70 / $1,298.70
| Facility | | $1,298.70 | $1,298.70 | $1,298.70 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $5,584.36 / $9,552.48 / $21,140.84
| Facility | 50 | $5,584.36 | $9,552.48 | $21,140.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47,000.00 / $81,499.99 / $94,999.99
| Facility | | $47,000.00 | $81,499.99 | $94,999.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $592.58 / $592.58 / $592.58
| Facility | | $592.58 | $592.58 | $592.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $291.86 / $900.90 / $954.44
| Facility | | $291.86 | $900.90 | $954.44 |