- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $10,471.29 / $18,197.01
| Facility | | $7,413.10 | $10,471.29 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $9,332.54 / $17,782.79
| Facility | | $2,187.76 | $9,332.54 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $891.25 / $4,570.88
| Facility | | $707.95 | $891.25 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $5,495.41 / $5,495.41 / $5,495.41
| Facility | 22 | $5,495.41 | $5,495.41 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $2,884.03 / $2,884.03 / $2,884.03
| Facility | 62 | $2,884.03 | $2,884.03 | $2,884.03 |
- 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 / $3,801.89 / $6,025.60
| Facility | | $2,630.27 | $3,801.89 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $17,378.01 / $26,302.68
| Facility | | $3,630.78 | $17,378.01 | $26,302.68 |