- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,280.77 / $1,280.77 / $5,519.00
| Facility | | $1,280.77 | $1,280.77 | $5,519.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $6,833.60 / $8,638.33 / $10,600.80
| Facility | 50 | $6,833.60 | $8,638.33 | $10,600.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $841.57 / $1,173.66 / $1,455.75
| Facility | | $841.57 | $1,173.66 | $1,455.75 |
- 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 |