- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $735.54 / $3,067.26 / $3,746.89
| Facility | | $735.54 | $3,067.26 | $3,746.89 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,897.66 / $4,793.30 / $6,491.69
| Facility | 50 | $3,897.66 | $4,793.30 | $6,491.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $485.00 / $513.90 / $1,018.46
| Facility | | $485.00 | $513.90 | $1,018.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $465.99 / $535.89 / $746.01
| Professional | | $465.99 | $535.89 | $746.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,009.00 / $1,009.00 / $1,009.00
| Facility | | $1,009.00 | $1,009.00 | $1,009.00 |