- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $820.50 / $1,341.00 / $2,250.00
| Facility | | $820.50 | $1,341.00 | $2,250.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,418.00 / $14,034.75 / $14,034.75
| Facility | 50 | $2,418.00 | $14,034.75 | $14,034.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,881.89 / $4,699.34 / $6,322.12
| Facility | | $3,881.89 | $4,699.34 | $6,322.12 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $5,822.84 / $7,049.02 / $9,483.19
| Facility | 50 | $5,822.84 | $7,049.02 | $9,483.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $950.00 / $3,129.00 / $5,251.00
| Facility | | $950.00 | $3,129.00 | $5,251.00 |