- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $486.47 / $1,268.00 / $2,639.00
| Facility | | $486.47 | $1,268.00 | $2,639.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,728.00 / $1,728.00 / $1,728.00
| Facility | 50 | $1,728.00 | $1,728.00 | $1,728.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,747.87 / $3,326.51 / $4,475.22
| Facility | | $2,747.87 | $3,326.51 | $4,475.22 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $4,121.80 / $4,989.77 / $6,712.84
| Facility | 50 | $4,121.80 | $4,989.77 | $6,712.84 |
- 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 |