- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.79 / $3,090.30 / $10,964.78
| Facility | | $0.79 | $3,090.30 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $151.36 / $316.23
| Professional | | $125.89 | $151.36 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $177.83 / $239.88
| Professional | | $123.03 | $177.83 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $245.47 / $323.59
| Facility | | $34.67 | $245.47 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $24.55 / $24.55 / $24.55
| Facility | AS | $24.55 | $24.55 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $190.55 / $309.03
| Professional | | $120.23 | $190.55 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $2,630.27 / $6,309.57
| Facility | | $1,348.96 | $2,630.27 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $107.15 / $165.96
| Professional | | $87.10 | $107.15 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $173.78
| Professional | | $32.36 | $33.11 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $1,778.28 / $4,168.69
| Facility | | $346.74 | $1,778.28 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $158.49 / $275.42
| Professional | | $109.65 | $158.49 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $109.65 / $144.54
| Professional | | $109.65 | $109.65 | $144.54 |