- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,070.60 / $1,070.60 / $8,622.00
| Facility | | $1,070.60 | $1,070.60 | $8,622.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $8,605.44 / $8,605.44 / $8,605.44
| Facility | 50 | $8,605.44 | $8,605.44 | $8,605.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $518.22 / $780.52 / $953.66
| Facility | | $518.22 | $780.52 | $953.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,693.55 / $8,522.07 / $10,689.08
| Facility | | $4,693.55 | $8,522.07 | $10,689.08 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $6,385.22 / $12,783.11 / $16,471.71
| Facility | 50 | $6,385.22 | $12,783.11 | $16,471.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,550.00 / $6,897.94 / $12,233.00
| Facility | | $5,550.00 | $6,897.94 | $12,233.00 |