- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $11,481.54 / $33,884.42
| Facility | | $2,884.03 | $11,481.54 | $33,884.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $16,218.10 / $27,542.29
| Facility | | $11,748.98 | $16,218.10 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,128.31 / $9,549.93 / $15,135.61
| Facility | | $8,128.31 | $9,549.93 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $6,918.31 / $13,489.63
| Facility | | $3,388.44 | $6,918.31 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $4,265.80 / $7,943.28
| Facility | | $2,691.53 | $4,265.80 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,073.80 / $7,943.28 / $13,489.63
| Professional | | $4,073.80 | $7,943.28 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $44,668.36 / $44,668.36
| Facility | | $7,943.28 | $44,668.36 | $44,668.36 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $5,011.87 / $5,011.87 / $28,183.83
| Facility | 62 | $5,011.87 | $5,011.87 | $28,183.83 |
- 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 |