- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,172.50 / $3,172.50 / $6,380.21
| Facility | | $3,172.50 | $3,172.50 | $6,380.21 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,783.50 / $3,783.50 / $3,783.50
| Facility | 50 | $3,783.50 | $3,783.50 | $3,783.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $484.22 / $706.07 / $1,140.17
| Professional | | $484.22 | $706.07 | $1,140.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $576.72 / $627.89 / $684.10
| Facility | | $576.72 | $627.89 | $684.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $531.09 / $575.55 / $680.21
| Professional | | $531.09 | $575.55 | $680.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $619.97 / $619.97 / $619.97
| Facility | | $619.97 | $619.97 | $619.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.44 / $658.76 / $2,717.60
| Professional | | $501.44 | $658.76 | $2,717.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $403.05 / $537.40 / $800.50
| Professional | | $403.05 | $537.40 | $800.50 |