- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $356.79 / $356.79 / $3,284.25
| Facility | | $356.79 | $356.79 | $3,284.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.81 / $356.79 / $602.60
| Professional | | $316.81 | $356.79 | $602.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,643.08 / $3,542.66 / $7,138.18
| Facility | | $1,643.08 | $3,542.66 | $7,138.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $650.92 / $1,050.67 / $1,374.96
| Professional | | $650.92 | $1,050.67 | $1,374.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.76 / $1,278.05 / $3,074.51
| Facility | | $900.76 | $1,278.05 | $3,074.51 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $263.31 / $263.31 / $263.31
| Facility | 62 | $263.31 | $263.31 | $263.31 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $42.13 / $42.13 / $42.13
| Facility | AS | $42.13 | $42.13 | $42.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $675.02 / $1,075.30 / $1,596.98
| Professional | | $675.02 | $1,075.30 | $1,596.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $818.87 / $1,168.44 / $2,420.88
| Facility | | $818.87 | $1,168.44 | $2,420.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $611.15 / $961.39 / $1,464.53
| Professional | | $611.15 | $961.39 | $1,464.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $383.88 / $645.61 / $4,708.43
| Facility | | $383.88 | $645.61 | $4,708.43 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $595.60 / $595.60 / $595.60
| Facility | 62 | $595.60 | $595.60 | $595.60 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $95.30 / $95.30 / $95.30
| Facility | AS | $95.30 | $95.30 | $95.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $391.84 / $711.66 / $1,441.83
| Professional | | $391.84 | $711.66 | $1,441.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,412.00 / $4,746.00 / $8,812.00
| Facility | | $2,412.00 | $4,746.00 | $8,812.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $391.84 / $712.44 / $1,430.15
| Professional | | $391.84 | $712.44 | $1,430.15 |