- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,009.19 / $3,033.31 / $8,584.79
| Facility | | $1,009.19 | $3,033.31 | $8,584.79 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $8,572.79 / $22,628.80 / $27,363.74
| Facility | 50 | $8,572.79 | $22,628.80 | $27,363.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $487.66 / $771.86 / $971.72
| Facility | | $487.66 | $771.86 | $971.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,746.17 / $17,361.59 / $22,059.79
| Facility | | $9,746.17 | $17,361.59 | $22,059.79 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $13,258.94 / $26,042.39 / $33,802.19
| Facility | 50 | $13,258.94 | $26,042.39 | $33,802.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,120.00 / $22,317.00 / $27,159.00
| Facility | | $10,120.00 | $22,317.00 | $27,159.00 |