- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $10,715.19 / $25,703.96
| Facility | | $4,466.84 | $10,715.19 | $25,703.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,220.18 / $16,595.87 / $28,840.32
| Facility | | $11,220.18 | $16,595.87 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $61.66 / $100.00 / $14,791.08
| Facility | | $61.66 | $100.00 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $3,235.94 / $4,073.80
| Professional | | $2,137.96 | $3,235.94 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,801.89 / $7,244.36
| Professional | | $2,884.03 | $3,801.89 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $56.23 / $44,668.36
| Facility | | $54.95 | $56.23 | $44,668.36 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $28,183.83 / $28,183.83 / $28,183.83
| Facility | 62 | $28,183.83 | $28,183.83 | $28,183.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $4,265.80 / $6,456.54
| Facility | | $3,311.31 | $4,265.80 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $6,165.95 / $18,620.87
| Facility | | $1,995.26 | $6,165.95 | $18,620.87 |