- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,532.13 / $4,500.00 / $7,761.00
| Facility | | $1,532.13 | $4,500.00 | $7,761.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,298.19 / $2,298.19 / $2,298.19
| Facility | 50 | $2,298.19 | $2,298.19 | $2,298.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $237.53 / $444.13 / $628.13
| Facility | | $237.53 | $444.13 | $628.13 |
- 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 |