- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $3,090.30 / $7,079.46
| Professional | | $251.19 | $3,090.30 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $14,125.38 / $14,125.38 / $14,791.08
| Professional | 50 | $14,125.38 | $14,125.38 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $549.54 / $4,897.79
| Professional | | $288.40 | $549.54 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $426.58 / $831.76 / $7,413.10
| Professional | 50 | $426.58 | $831.76 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $39.81 / $77.62 / $691.83
| Professional | AS | $39.81 | $77.62 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $3,890.45 / $5,754.40
| Professional | | $316.23 | $3,890.45 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $3,715.35 / $5,754.40
| Professional | | $269.15 | $3,715.35 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $3,311.31 / $7,079.46
| Professional | | $229.09 | $3,311.31 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $14,125.38 / $14,125.38 / $14,791.08
| Professional | 50 | $14,125.38 | $14,125.38 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $2,884.03 / $6,456.54
| Professional | | $309.03 | $2,884.03 | $6,456.54 |