- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,200.42 / $4,889.39 / $7,120.36
| Facility | | $2,200.42 | $4,889.39 | $7,120.36 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,378.75 / $3,378.75 / $3,378.75
| Facility | 50 | $3,378.75 | $3,378.75 | $3,378.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $598.35 / $842.90 / $2,277.46
| Professional | | $598.35 | $842.90 | $2,277.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.73 / $1,991.97 / $9,874.90
| Facility | | $1,146.73 | $1,991.97 | $9,874.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,241.75 / $2,006.40 / $3,123.31
| Facility | | $1,241.75 | $2,006.40 | $3,123.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $6,588.00 / $10,320.00
| Facility | | $5,341.00 | $6,588.00 | $10,320.00 |