- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $10,471.29 / $17,782.79
| Facility | | $5,623.41 | $10,471.29 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,803.84 / $18,620.87 / $29,512.09
| Facility | | $13,803.84 | $18,620.87 | $29,512.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,182.57 / $15,488.17 / $24,547.09
| Facility | | $13,182.57 | $15,488.17 | $24,547.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $6,456.54 / $11,220.18
| Facility | | $4,570.88 | $6,456.54 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $6,025.60 / $11,220.18
| Facility | | $3,981.07 | $6,025.60 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $15,488.17 / $15,488.17 / $15,488.17
| Facility | 62 | $15,488.17 | $15,488.17 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,606.93 / $11,748.98 / $18,197.01
| Professional | | $6,606.93 | $11,748.98 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,182.57 / $186,208.71 / $186,208.71
| Facility | | $13,182.57 | $186,208.71 | $186,208.71 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $8,317.64 / $8,317.64 / $117,489.76
| Facility | 62 | $8,317.64 | $8,317.64 | $117,489.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $6,165.95 / $19,498.45
| Facility | | $2,290.87 | $6,165.95 | $19,498.45 |