- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,991.80 / $12,226.90 / $20,698.50
| Facility | | $1,991.80 | $12,226.90 | $20,698.50 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $7,120.14 / $13,774.64 / $25,440.25
| Facility | 50 | $7,120.14 | $13,774.64 | $25,440.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $757.09 / $1,134.74 / $1,452.47
| Facility | | $757.09 | $1,134.74 | $1,452.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,788.65 / $14,025.11 / $17,482.34
| Facility | | $9,788.65 | $14,025.11 | $17,482.34 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $13,316.72 / $21,037.67 / $27,262.55
| Facility | 50 | $13,316.72 | $21,037.67 | $27,262.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,800.00 / $26,422.00 / $29,092.00
| Facility | | $11,800.00 | $26,422.00 | $29,092.00 |