- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $8,128.31 / $10,471.29
| Facility | | $2,630.27 | $8,128.31 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $602.56 / $602.56
| Facility | | $602.56 | $602.56 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,786.30 / $4,786.30 / $6,309.57
| Professional | | $4,786.30 | $4,786.30 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $3,630.78 / $5,754.40
| Facility | | $2,630.27 | $3,630.78 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $12,302.69 / $19,054.61
| Facility | | $4,168.69 | $12,302.69 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $27,542.29 / $27,542.29
| Facility | | $1,995.26 | $27,542.29 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $17,378.01 / $17,378.01 / $17,378.01
| Facility | 62 | $17,378.01 | $17,378.01 | $17,378.01 |