- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,294.50 / $1,294.50 / $5,519.00
| Facility | | $1,294.50 | $1,294.50 | $5,519.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,557.80 / $2,557.80 / $7,551.19
| Facility | 50 | $2,557.80 | $2,557.80 | $7,551.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $508.15 / $759.55 / $1,392.41
| Facility | | $508.15 | $759.55 | $1,392.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,425.14 / $16,141.46 / $20,737.38
| Facility | | $11,425.14 | $16,141.46 | $20,737.38 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $16,944.23 / $24,212.19 / $32,338.58
| Facility | 50 | $16,944.23 | $24,212.19 | $32,338.58 |
- 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 |