- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,204.23 / $7,119.70 / $14,482.00
| Facility | | $3,204.23 | $7,119.70 | $14,482.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,499.00 / $16,401.00 / $25,162.36
| Facility | | $11,499.00 | $16,401.00 | $25,162.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,910.27 / $10,412.36 / $16,794.77
| Facility | | $8,910.27 | $10,412.36 | $16,794.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,204.23 / $4,069.31 / $6,803.27
| Facility | | $3,204.23 | $4,069.31 | $6,803.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,803.00 / $4,602.00 / $7,868.00
| Facility | | $2,803.00 | $4,602.00 | $7,868.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,204.23 / $4,069.31 / $6,803.27
| Facility | | $3,204.23 | $4,069.31 | $6,803.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,356.05 / $11,317.00 / $15,230.03
| Professional | | $7,356.05 | $11,317.00 | $15,230.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51,283.32 / $51,283.32 / $51,283.32
| Facility | | $51,283.32 | $51,283.32 | $51,283.32 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $10,707.40 / $10,707.40 / $10,707.40
| Facility | 62 | $10,707.40 | $10,707.40 | $10,707.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,203.00 / $4,316.80 / $19,003.00
| Facility | | $2,203.00 | $4,316.80 | $19,003.00 |