- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $3,715.35 / $6,918.31
| Facility | | $1,621.81 | $3,715.35 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $549.54 / $2,511.89
| Professional | | $199.53 | $549.54 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $1,862.09 / $5,011.87
| Facility | | $457.09 | $1,862.09 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $2,041.74 / $2,041.74 / $2,041.74
| Facility | 62 | $2,041.74 | $2,041.74 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $331.13 / $331.13 / $331.13
| Facility | AS | $331.13 | $331.13 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $316.23 / $3,630.78
| Professional | | $186.21 | $316.23 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $407.38 / $537.03
| Professional | | $239.88 | $407.38 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $1,995.26 / $1,995.26
| Facility | | $1,995.26 | $1,995.26 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $331.13 / $562.34
| Professional | | $213.80 | $331.13 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $389.05 / $7,079.46
| Facility | | $186.21 | $389.05 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $251.19 / $354.81
| Professional | | $204.17 | $251.19 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $2,041.74 / $14,454.40
| Facility | | $630.96 | $2,041.74 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $346.74 / $524.81
| Professional | | $190.55 | $346.74 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,071.52 / $1,949.84
| Facility | | $1,071.52 | $1,071.52 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $316.23 / $851.14
| Professional | | $93.33 | $316.23 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $1,862.09 / $5,011.87
| Facility | | $457.09 | $1,862.09 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $2,041.74 / $2,041.74 / $2,041.74
| Facility | 62 | $2,041.74 | $2,041.74 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $331.13 / $331.13 / $331.13
| Facility | AS | $331.13 | $331.13 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $316.23 / $3,630.78
| Professional | | $186.21 | $316.23 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $1,862.09 / $13,182.57
| Facility | | $630.96 | $1,862.09 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $309.03 / $588.84
| Professional | | $204.17 | $309.03 | $588.84 |