- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,175.56 / $2,175.56 / $19,507.00
| Professional | | $2,175.56 | $2,175.56 | $19,507.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $767.33 / $993.06 / $5,472.16
| Professional | | $767.33 | $993.06 | $5,472.16 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $1,151.00 / $1,489.59 / $8,208.24
| Professional | 50 | $1,151.00 | $1,489.59 | $8,208.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $629.02 / $1,181.40 / $6,352.42
| Professional | | $629.02 | $1,181.40 | $6,352.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.21 / $2,931.36 / $4,983.31
| Facility | | $389.21 | $2,931.36 | $4,983.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,041.33 / $5,795.47 / $7,702.54
| Professional | | $3,041.33 | $5,795.47 | $7,702.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,703.67 / $6,172.78 / $7,702.54
| Professional | | $3,703.67 | $6,172.78 | $7,702.54 |