- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $746.78 / $4,612.83 / $10,111.79
| Facility | | $746.78 | $4,612.83 | $10,111.79 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $6,363.38 / $6,363.38 / $6,363.38
| Facility | 50 | $6,363.38 | $6,363.38 | $6,363.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $507.00 / $518.54 / $3,314.62
| Facility | | $507.00 | $518.54 | $3,314.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.46 / $832.64 / $1,096.72
| Professional | | $645.46 | $832.64 | $1,096.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $643.00 / $643.00 / $1,185.00
| Facility | | $643.00 | $643.00 | $1,185.00 |