- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $6,025.60 / $15,848.93
| Facility | | $1,548.82 | $6,025.60 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $10,000.00 / $18,197.01
| Facility | | $8,912.51 | $10,000.00 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $5,495.41 / $5,495.41
| Facility | | $5,495.41 | $5,495.41 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,302.69 / $12,302.69 / $12,302.69
| Facility | | $12,302.69 | $12,302.69 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,302.69 / $12,302.69 / $12,302.69
| Facility | | $12,302.69 | $12,302.69 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $831.76 / $1,318.26
| Facility | | $831.76 | $831.76 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $478.63 / $478.63 / $478.63
| Facility | 62 | $478.63 | $478.63 | $478.63 |