- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.65 / $4,570.88 / $10,715.19
| Facility | | $109.65 | $4,570.88 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $0.51 / $0.51 / $0.51
| Facility | 50 | $0.51 | $0.51 | $0.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $616.60 / $2,511.89
| Facility | | $316.23 | $616.60 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $1,023.29 / $1,778.28
| Facility | | $831.76 | $1,023.29 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $1,737.80 / $4,168.69
| Facility | | $269.15 | $1,737.80 | $4,168.69 |