- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,162.58 / $1,162.58 / $5,519.00
| Facility | | $1,162.58 | $1,162.58 | $5,519.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $10,483.79 / $10,483.79 / $10,483.79
| Facility | 50 | $10,483.79 | $10,483.79 | $10,483.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $637.27 / $1,025.81 / $1,220.67
| Facility | | $637.27 | $1,025.81 | $1,220.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,871.35 / $8,752.65 / $11,549.09
| Facility | | $6,871.35 | $8,752.65 | $11,549.09 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $9,189.03 / $13,128.98 / $18,010.05
| Facility | 50 | $9,189.03 | $13,128.98 | $18,010.05 |
- 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 |