- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,966.90 / $1,966.90 / $28,847.10
| Facility | | $1,966.90 | $1,966.90 | $28,847.10 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $7,768.80 / $18,564.34 / $27,588.76
| Facility | 50 | $7,768.80 | $18,564.34 | $27,588.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,285.51 / $1,752.03 / $2,166.21
| Facility | | $1,285.51 | $1,752.03 | $2,166.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,735.84 / $15,339.80 / $19,820.41
| Facility | | $10,735.84 | $15,339.80 | $19,820.41 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $14,624.12 / $23,009.70 / $30,811.46
| Facility | 50 | $14,624.12 | $23,009.70 | $30,811.46 |
- 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 |