- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,071.86 / $6,774.95 / $12,994.00
| Facility | | $2,071.86 | $6,774.95 | $12,994.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,120.92 / $8,027.02 / $16,066.94
| Facility | 50 | $2,120.92 | $8,027.02 | $16,066.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,220.25 / $7,942.74 / $16,407.18
| Facility | | $2,220.25 | $7,942.74 | $16,407.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $815.00 / $3,413.02 / $4,385.79
| Facility | | $815.00 | $3,413.02 | $4,385.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $710.00 / $946.96 / $1,697.49
| Facility | | $710.00 | $946.96 | $1,697.49 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,065.00 / $1,412.82 / $2,433.41
| Facility | 50 | $1,065.00 | $1,412.82 | $2,433.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $16,959.00 / $23,485.00
| Facility | | $2,912.00 | $16,959.00 | $23,485.00 |