- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $3,162.28 / $7,413.10
| Facility | | $645.65 | $3,162.28 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,479.11 / $2,238.72 / $7,943.28
| Facility | 50 | $1,479.11 | $2,238.72 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $3,467.37 / $9,772.37
| Facility | | $1,071.52 | $3,467.37 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $7,244.36 / $9,772.37
| Facility | | $4,168.69 | $7,244.36 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $870.96 / $1,445.44
| Professional | | $724.44 | $870.96 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $7,244.36 / $14,125.38
| Facility | | $1,737.80 | $7,244.36 | $14,125.38 |