- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.79 / $4,959.21 / $9,709.52
| Facility | | $56.79 | $4,959.21 | $9,709.52 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,568.48 / $4,866.31 / $7,975.37
| Facility | 50 | $1,568.48 | $4,866.31 | $7,975.37 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $5,370.59 / $5,370.59 / $5,370.59
| Facility | 80 | $5,370.59 | $5,370.59 | $5,370.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,016.21 / $3,016.21 / $3,016.21
| Facility | | $3,016.21 | $3,016.21 | $3,016.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $678.16 / $901.95 / $1,450.25
| Professional | | $678.16 | $901.95 | $1,450.25 |