- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $4,897.79 / $8,912.51
| Facility | | $2,290.87 | $4,897.79 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,079.46 / $12,589.25 / $16,982.44
| Facility | | $7,079.46 | $12,589.25 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $34.67 / $3,890.45
| Facility | | $34.67 | $34.67 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $2,398.83 / $2,398.83 / $2,398.83
| Facility | 62 | $2,398.83 | $2,398.83 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,238.72 / $2,691.53
| Professional | | $1,905.46 | $2,238.72 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,090.30 / $3,090.30 / $3,890.45
| Professional | | $3,090.30 | $3,090.30 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,570.40 / $4,265.80
| Facility | | $1,995.26 | $2,570.40 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $3,090.30 / $10,000.00
| Facility | | $2,089.30 | $3,090.30 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $7,079.46 / $14,125.38
| Facility | | $3,715.35 | $7,079.46 | $14,125.38 |