- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $967.78 / $1,096.82 / $5,519.00
| Facility | | $967.78 | $1,096.82 | $5,519.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,557.80 / $4,253.57 / $26,489.60
| Facility | 50 | $2,557.80 | $4,253.57 | $26,489.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.82 / $921.70 / $1,179.78
| Facility | | $446.82 | $921.70 | $1,179.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,953.27 / $16,141.46 / $20,737.38
| Facility | | $7,953.27 | $16,141.46 | $20,737.38 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $11,679.45 / $24,212.19 / $32,338.58
| Facility | 50 | $11,679.45 | $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 |