- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.28 / $3,759.70 / $8,475.50
| Facility | | $954.28 | $3,759.70 | $8,475.50 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,261.95 / $4,819.58 / $6,904.04
| Facility | 50 | $3,261.95 | $4,819.58 | $6,904.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,385.00 / $4,133.00 / $8,800.00
| Facility | | $2,385.00 | $4,133.00 | $8,800.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $790.00 / $949.77 / $1,304.32
| Facility | | $790.00 | $949.77 | $1,304.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,683.00 / $3,833.00 / $7,790.50
| Facility | | $1,683.00 | $3,833.00 | $7,790.50 |