- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.89 / $190.55 / $7,244.36
| Facility | | $0.89 | $190.55 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $380.19 / $2,187.76
| Professional | | $190.55 | $380.19 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.54 / $4,168.69 / $6,456.54
| Facility | | $144.54 | $4,168.69 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $501.19 / $758.58
| Professional | | $331.13 | $501.19 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $707.95 / $1,659.59
| Facility | | $489.78 | $707.95 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $426.58 / $426.58 / $426.58
| Facility | 22 | $426.58 | $426.58 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $223.87 / $223.87 / $223.87
| Facility | 62 | $223.87 | $223.87 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $35.48 / $35.48 / $35.48
| Facility | AS | $35.48 | $35.48 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $562.34 / $851.14
| Professional | | $338.84 | $562.34 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $676.08 / $1,318.26
| Facility | | $537.03 | $676.08 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $478.63 / $758.58
| Professional | | $363.08 | $478.63 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $389.05 / $2,691.53
| Facility | | $208.93 | $389.05 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $426.58 / $2,290.87
| Professional | | $213.80 | $426.58 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $2,951.21 / $8,511.38
| Facility | | $602.56 | $2,951.21 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $363.08 / $741.31
| Professional | | $204.17 | $363.08 | $741.31 |