- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $205.60 / $927.00 / $2,639.00
| Facility | | $205.60 | $927.00 | $2,639.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $753.86 / $753.86 / $5,381.23
| Facility | 50 | $753.86 | $753.86 | $5,381.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,613.64 / $3,164.02 / $4,256.62
| Facility | | $2,613.64 | $3,164.02 | $4,256.62 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,920.46 / $4,746.03 / $6,384.93
| Facility | 50 | $3,920.46 | $4,746.03 | $6,384.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $241.00 / $850.00 / $1,349.00
| Facility | | $241.00 | $850.00 | $1,349.00 |