- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $634.51 / $1,520.00 / $2,250.00
| Facility | | $634.51 | $1,520.00 | $2,250.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,900.00 / $3,778.13 / $7,500.00
| Facility | 50 | $1,900.00 | $3,778.13 | $7,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,321.85 / $5,231.95 / $7,038.65
| Facility | | $4,321.85 | $5,231.95 | $7,038.65 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $6,482.78 / $7,847.92 / $10,557.97
| Facility | 50 | $6,482.78 | $7,847.92 | $10,557.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,124.00 / $3,384.00 / $5,251.00
| Facility | | $1,124.00 | $3,384.00 | $5,251.00 |