- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,360.81 / $7,546.30 / $13,749.07
| Facility | | $1,360.81 | $7,546.30 | $13,749.07 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $11,008.91 / $11,008.91 / $11,319.45
| Facility | 50 | $11,008.91 | $11,008.91 | $11,319.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,214.76 / $4,214.76 / $4,226.60
| Facility | | $4,214.76 | $4,214.76 | $4,226.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $884.60 / $1,664.38 / $2,750.36
| Facility | | $884.60 | $1,664.38 | $2,750.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,653.11 / $17,361.59 / $22,059.79
| Facility | | $10,653.11 | $17,361.59 | $22,059.79 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $14,492.76 / $26,042.39 / $33,802.19
| Facility | 50 | $14,492.76 | $26,042.39 | $33,802.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,600.00 / $11,800.00 / $29,092.00
| Facility | | $2,600.00 | $11,800.00 | $29,092.00 |