- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $618.83 / $1,100.00 / $2,250.00
| Facility | | $618.83 | $1,100.00 | $2,250.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $476.28 / $476.28 / $2,589.44
| Facility | 50 | $476.28 | $476.28 | $2,589.44 |
- 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
- $1,124.00 / $3,384.00 / $5,251.00
| Facility | | $1,124.00 | $3,384.00 | $5,251.00 |