- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $2,398.83 / $4,897.79
| Facility | | $1,778.28 | $2,398.83 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,445.44 / $1,445.44 / $1,698.24
| Facility | 50 | $1,445.44 | $1,445.44 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $162.18 / $416.87
| Professional | | $138.04 | $162.18 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $186.21 / $275.42
| Professional | | $138.04 | $186.21 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $3,388.44 / $5,370.32
| Facility | | $3,388.44 | $3,388.44 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $169.82 / $269.15
| Professional | | $125.89 | $169.82 | $269.15 |