- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $949.63 / $1,286.96 / $9,601.95
| Facility | | $949.63 | $1,286.96 | $9,601.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $949.63 / $1,170.33 / $8,321.41
| Professional | | $949.63 | $1,170.33 | $8,321.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.06 / $390.18 / $3,524.12
| Professional | | $212.06 | $390.18 | $3,524.12 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $665.32 / $1,126.01 / $4,153.43
| Professional | 50 | $665.32 | $1,126.01 | $4,153.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,512.00 / $7,194.00 / $13,734.00
| Facility | | $3,512.00 | $7,194.00 | $13,734.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $527.12 / $2,881.84 / $7,855.16
| Professional | | $527.12 | $2,881.84 | $7,855.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $4,897.51 / $4,897.51
| Facility | | $55.00 | $4,897.51 | $4,897.51 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $217.54 / $223.74 / $223.74
| Facility | AS | $217.54 | $223.74 | $223.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13,544.27 / $23,107.71 / $24,517.50
| Professional | | $13,544.27 | $23,107.71 | $24,517.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,012.08 / $6,453.21 / $8,883.92
| Professional | | $4,012.08 | $6,453.21 | $8,883.92 |