- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $5,888.44 / $34,673.69
| Facility | | $1,621.81 | $5,888.44 | $34,673.69 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,344.23 / $2,344.23 / $2,344.23
| Facility | 50 | $2,344.23 | $2,344.23 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $2,818.38 / $2,818.38
| Facility | | $2,818.38 | $2,818.38 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,380.38 / $2,454.71
| Professional | | $1,202.26 | $1,380.38 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $2,884.03 / $2,884.03
| Facility | | $2,884.03 | $2,884.03 | $2,884.03 |