- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,206.58 / $3,935.40 / $9,984.28
| Facility | | $1,206.58 | $3,935.40 | $9,984.28 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $15,776.00 / $15,776.00 / $15,776.00
| Facility | 50 | $15,776.00 | $15,776.00 | $15,776.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $792.84 / $1,074.78 / $1,297.83
| Facility | | $792.84 | $1,074.78 | $1,297.83 |
- 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 |