- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,368.82 / $3,828.88 / $20,091.18
| Facility | | $1,368.82 | $3,828.88 | $20,091.18 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $4,460.39 / $5,270.76 / $28,230.23
| Facility | 50 | $4,460.39 | $5,270.76 | $28,230.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $923.19 / $1,256.69 / $1,705.26
| Facility | | $923.19 | $1,256.69 | $1,705.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,304.88 / $23,969.22 / $29,367.14
| Facility | | $17,304.88 | $23,969.22 | $29,367.14 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $25,489.85 / $35,953.83 / $44,539.86
| Facility | 50 | $25,489.85 | $35,953.83 | $44,539.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,800.00 / $15,872.00 / $70,019.00
| Facility | | $11,800.00 | $15,872.00 | $70,019.00 |