- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,369.54 / $1,369.54 / $5,519.00
| Facility | | $1,369.54 | $1,369.54 | $5,519.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,854.97 / $4,253.57 / $26,489.60
| Facility | 50 | $3,854.97 | $4,253.57 | $26,489.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $538.40 / $803.98 / $1,473.13
| Facility | | $538.40 | $803.98 | $1,473.13 |
- 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 |