- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $4,786.30 / $8,317.64
| Facility | | $1,348.96 | $4,786.30 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $4,168.69 / $4,168.69 / $4,168.69
| Facility | 50 | $4,168.69 | $4,168.69 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $2,884.03 / $6,025.60
| Facility | | $1,148.15 | $2,884.03 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $1,737.80 / $2,187.76
| Facility | | $776.25 | $1,737.80 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,148.15 / $6,309.57
| Professional | | $794.33 | $1,148.15 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- 80
- Low / Median / High Price
- $54.95 / $54.95 / $85.11
| Professional | 80 | $54.95 | $54.95 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $5,248.07 / $8,511.38
| Facility | | $1,000.00 | $5,248.07 | $8,511.38 |