- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,422.00 / $5,519.00 / $12,953.97
| Facility | | $3,422.00 | $5,519.00 | $12,953.97 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $17,080.80 / $17,080.80 / $17,080.80
| Facility | 50 | $17,080.80 | $17,080.80 | $17,080.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $934.93 / $1,253.50 / $1,508.16
| Facility | | $934.93 | $1,253.50 | $1,508.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,803.07 / $15,339.80 / $19,820.41
| Facility | | $7,803.07 | $15,339.80 | $19,820.41 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $11,127.92 / $23,009.70 / $30,811.46
| Facility | 50 | $11,127.92 | $23,009.70 | $30,811.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,360.00 / $16,762.00 / $17,870.00
| Facility | | $9,360.00 | $16,762.00 | $17,870.00 |