- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,451.58 / $3,981.14 / $12,053.89
| Facility | | $1,451.58 | $3,981.14 | $12,053.89 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $6,094.88 / $6,094.88 / $33,044.50
| Facility | 50 | $6,094.88 | $6,094.88 | $33,044.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $796.80 / $1,280.81 / $1,498.38
| Facility | | $796.80 | $1,280.81 | $1,498.38 |
- 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 / $22,317.00 / $27,159.00
| Facility | | $10,120.00 | $22,317.00 | $27,159.00 |