- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $4,365.16 / $5,011.87
| Facility | | $389.05 | $4,365.16 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $870.96 / $3,162.28
| Facility | | $457.09 | $870.96 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $7,244.36 / $7,244.36 / $7,244.36
| Facility | 50 | $7,244.36 | $7,244.36 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $831.76 / $870.96
| Professional | | $776.25 | $831.76 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $724.44 / $851.14
| Professional | | $512.86 | $724.44 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,162.28 / $3,162.28
| Facility | | $3,162.28 | $3,162.28 | $3,162.28 |