- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,136.73 / $1,728.00 / $21,425.04
| Facility | | $1,136.73 | $1,728.00 | $21,425.04 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $11,341.76 / $11,341.76 / $11,341.76
| Facility | 50 | $11,341.76 | $11,341.76 | $11,341.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,674.66 / $5,659.05 / $7,613.24
| Facility | | $4,674.66 | $5,659.05 | $7,613.24 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $7,011.99 / $8,488.58 / $11,419.85
| Facility | 50 | $7,011.99 | $8,488.58 | $11,419.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,125.00 / $5,085.00 / $9,624.00
| Facility | | $2,125.00 | $5,085.00 | $9,624.00 |