- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,361.22 / $2,880.77 / $12,640.00
| Facility | | $1,361.22 | $2,880.77 | $12,640.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,353.68 / $5,904.80 / $25,280.00
| Facility | 50 | $3,353.68 | $5,904.80 | $25,280.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $706.17 / $1,143.89 / $1,464.18
| Facility | | $706.17 | $1,143.89 | $1,464.18 |
- 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 / $15,872.00 / $70,019.00
| Facility | | $10,120.00 | $15,872.00 | $70,019.00 |