- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $386.16 / $386.16 / $5,069.68
| Facility | | $386.16 | $386.16 | $5,069.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $451.54 / $757.01 / $1,339.97
| Facility | | $451.54 | $757.01 | $1,339.97 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $7,313.83 / $7,313.83 / $7,313.83
| Facility | 50 | $7,313.83 | $7,313.83 | $7,313.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $822.42 / $982.82 / $4,395.05
| Facility | | $822.42 | $982.82 | $4,395.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $513.10 / $694.50 / $843.03
| Professional | | $513.10 | $694.50 | $843.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,143.00 / $3,143.00 / $3,143.00
| Facility | | $3,143.00 | $3,143.00 | $3,143.00 |