- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $3,090.30 / $6,309.57
| Facility | | $1,445.44 | $3,090.30 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $630.96 / $630.96 / $630.96
| Facility | 50 | $630.96 | $630.96 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $323.59 / $478.63
| Facility | | $100.00 | $323.59 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $77.62 / $213.80 / $1,862.09
| Facility | | $77.62 | $213.80 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $1,513.56 / $3,235.94
| Facility | | $588.84 | $1,513.56 | $3,235.94 |