- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $891.25 / $1,621.81
| Facility | | $812.83 | $891.25 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $5,754.40 / $8,511.38 / $8,511.38
| Facility | 50 | $5,754.40 | $8,511.38 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,621.81 / $1,621.81
| Facility | | $1,621.81 | $1,621.81 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $724.44 / $1,148.15
| Professional | | $630.96 | $724.44 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,238.72 / $2,238.72
| Facility | | $2,238.72 | $2,238.72 | $2,238.72 |