- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $4,466.84 / $5,495.41
| Facility | | $3,388.44 | $4,466.84 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $2,089.30 / $4,466.84
| Facility | | $870.96 | $2,089.30 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,318.26 / $3,162.28 / $5,011.87
| Facility | 50 | $1,318.26 | $3,162.28 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $524.81 / $4,466.84
| Facility | | $100.00 | $524.81 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.97 / $1,819.70 / $9,332.54
| Facility | | $181.97 | $1,819.70 | $9,332.54 |