- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $895.75 / $5,643.46 / $13,950.77
| Facility | | $895.75 | $5,643.46 | $13,950.77 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,916.00 / $10,817.35 / $13,950.77
| Facility | 50 | $3,916.00 | $10,817.35 | $13,950.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,138.69 / $10,667.61 / $14,532.22
| Facility | | $9,138.69 | $10,667.61 | $14,532.22 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $6,164.01 / $7,266.11 / $9,476.27
| Facility | 50 | $6,164.01 | $7,266.11 | $9,476.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $940.53 / $4,933.00 / $10,139.46
| Facility | | $940.53 | $4,933.00 | $10,139.46 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,916.00 / $11,243.96 / $12,656.36
| Facility | 50 | $3,916.00 | $11,243.96 | $12,656.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,000.00 / $10,359.00 / $12,767.00
| Facility | | $5,000.00 | $10,359.00 | $12,767.00 |