- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $293.12 / $1,251.00 / $2,080.00
| Facility | | $293.12 | $1,251.00 | $2,080.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $308.75 / $1,551.56 / $1,551.56
| Facility | 50 | $308.75 | $1,551.56 | $1,551.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,014.54 / $1,228.18 / $1,652.30
| Facility | | $1,014.54 | $1,228.18 | $1,652.30 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,521.81 / $1,842.27 / $2,478.44
| Facility | 50 | $1,521.81 | $1,842.27 | $2,478.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $834.00 / $2,891.00 / $4,402.00
| Facility | | $834.00 | $2,891.00 | $4,402.00 |