- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $267.20 / $2,301.00 / $6,012.38
| Facility | | $267.20 | $2,301.00 | $6,012.38 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,172.00 / $1,611.73 / $3,310.75
| Facility | 50 | $1,172.00 | $1,611.73 | $3,310.75 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $0.40 / $0.40 / $0.40
| Facility | AS | $0.40 | $0.40 | $0.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.07 / $170.15 / $367.20
| Professional | | $123.07 | $170.15 | $367.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.00 / $4,247.00 / $7,875.00
| Facility | | $2,088.00 | $4,247.00 | $7,875.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.33 / $166.52 / $280.77
| Professional | | $131.33 | $166.52 | $280.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $312.48 / $323.00 / $630.14
| Facility | | $312.48 | $323.00 | $630.14 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $15.25 / $15.25 / $15.25
| Facility | AS | $15.25 | $15.25 | $15.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.35 / $212.60 / $326.23
| Professional | | $145.35 | $212.60 | $326.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $376.00 / $1,221.00 / $2,883.00
| Facility | | $376.00 | $1,221.00 | $2,883.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.08 / $198.75 / $323.82
| Professional | | $140.08 | $198.75 | $323.82 |