- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,320.70 / $1,730.54 / $4,448.32
| Facility | | $1,320.70 | $1,730.54 | $4,448.32 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,813.26 / $1,813.26 / $2,695.92
| Facility | 50 | $1,813.26 | $1,813.26 | $2,695.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.77 / $341.75 / $611.17
| Professional | | $255.77 | $341.75 | $611.17 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $622.44 / $911.92 / $925.04
| Professional | 50 | $622.44 | $911.92 | $925.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $303.49 / $336.35 / $366.46
| Facility | | $303.49 | $336.35 | $366.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $325.74 / $325.74 / $325.74
| Professional | | $325.74 | $325.74 | $325.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $486.64 / $486.64 / $486.64
| Facility | | $486.64 | $486.64 | $486.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $297.56 / $465.62 / $1,351.72
| Professional | | $297.56 | $465.62 | $1,351.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,067.90 / $3,067.90 / $5,954.35
| Facility | | $3,067.90 | $3,067.90 | $5,954.35 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,261.68 / $3,261.68 / $3,261.68
| Facility | 50 | $3,261.68 | $3,261.68 | $3,261.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $291.42 / $418.92 / $637.41
| Professional | | $291.42 | $418.92 | $637.41 |