- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.72 / $393.76 / $4,495.12
| Professional | | $241.72 | $393.76 | $4,495.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $307.48 / $496.22 / $5,081.85
| Professional | | $307.48 | $496.22 | $5,081.85 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $461.22 / $727.72 / $7,622.78
| Professional | 50 | $461.22 | $727.72 | $7,622.78 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $43.04 / $67.92 / $711.46
| Professional | AS | $43.04 | $67.92 | $711.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $315.87 / $3,918.62 / $5,767.55
| Professional | | $315.87 | $3,918.62 | $5,767.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $314.92 / $726.36 / $5,665.33
| Professional | | $314.92 | $726.36 | $5,665.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.72 / $393.76 / $4,495.12
| Professional | | $241.72 | $393.76 | $4,495.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,829.24 / $5,244.87 / $6,349.48
| Professional | | $3,829.24 | $5,244.87 | $6,349.48 |