- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $916.07 / $6,229.80 / $19,966.25
| Facility | | $916.07 | $6,229.80 | $19,966.25 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,193.66 / $2,193.66 / $2,193.66
| Facility | 50 | $2,193.66 | $2,193.66 | $2,193.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $458.93 / $736.68 / $985.36
| Facility | | $458.93 | $736.68 | $985.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,614.81 / $8,752.65 / $11,549.09
| Facility | | $6,614.81 | $8,752.65 | $11,549.09 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $9,189.03 / $14,036.54 / $18,010.05
| Facility | 50 | $9,189.03 | $14,036.54 | $18,010.05 |
- 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 |