- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $2,290.87 / $7,585.78
| Facility | | $251.19 | $2,290.87 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $676.08 / $3,019.95 / $8,511.38
| Facility | 50 | $676.08 | $3,019.95 | $8,511.38 |
- 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
- $123.03 / $204.17 / $512.86
| Professional | | $123.03 | $204.17 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $4,365.16 / $11,220.18
| Facility | | $2,344.23 | $4,365.16 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $181.97 / $338.84
| Professional | | $128.82 | $181.97 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.83 / $363.08 / $1,122.02
| Facility | | $131.83 | $363.08 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $23.44 / $23.44 / $23.44
| Facility | AS | $23.44 | $23.44 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $218.78 / $446.68
| Professional | | $144.54 | $218.78 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $1,202.26 / $3,630.78
| Facility | | $295.12 | $1,202.26 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $181.97 / $323.59
| Professional | | $123.03 | $181.97 | $323.59 |