- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $1,445.44 / $2,398.83
| Facility | | $489.78 | $1,445.44 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,737.80 / $1,737.80 / $1,737.80
| Facility | 50 | $1,737.80 | $1,737.80 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $3,388.44 / $4,570.88
| Facility | | $2,818.38 | $3,388.44 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $4,265.80 / $5,011.87 / $6,760.83
| Facility | 50 | $4,265.80 | $5,011.87 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $2,884.03 / $4,073.80
| Facility | | $831.76 | $2,884.03 | $4,073.80 |