- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $944.27 / $8,824.44 / $20,826.04
| Facility | | $944.27 | $8,824.44 | $20,826.04 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $11,060.70 / $11,060.70 / $16,165.78
| Facility | 50 | $11,060.70 | $11,060.70 | $16,165.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,851.90 / $3,851.90 / $3,851.90
| Facility | | $3,851.90 | $3,851.90 | $3,851.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,132.00 / $8,676.95 / $34,128.66
| Facility | | $6,132.00 | $8,676.95 | $34,128.66 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $32,749.11 / $32,749.11 / $32,749.11
| Facility | 50 | $32,749.11 | $32,749.11 | $32,749.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,783.00 / $2,783.00 / $2,783.00
| Facility | | $2,783.00 | $2,783.00 | $2,783.00 |