- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $426.58 / $457.09
| Professional | | $426.58 | $426.58 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $660.69 / $660.69 / $660.69
| Professional | 50 | $660.69 | $660.69 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $6,918.31 / $8,709.64
| Professional | | $1,023.29 | $6,918.31 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $5,370.32 / $15,488.17
| Facility | | $630.96 | $5,370.32 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $218.78 / $218.78 / $218.78
| Facility | AS | $218.78 | $218.78 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $7,585.78 / $13,489.63
| Professional | | $1,122.02 | $7,585.78 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $6,309.57 / $9,772.37
| Professional | | $1,122.02 | $6,309.57 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $6,309.57
| Professional | | $1,000.00 | $1,000.00 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $9,332.54 / $13,489.63
| Facility | | $9,120.11 | $9,332.54 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $4,570.88 / $8,912.51
| Professional | | $691.83 | $4,570.88 | $8,912.51 |