- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $5,128.61 / $11,748.98
| Facility | | $1,949.84 | $5,128.61 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $10,964.78 / $22,908.68
| Facility | | $3,801.89 | $10,964.78 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $6,918.31 / $19,498.45
| Facility | | $323.59 | $6,918.31 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $5,495.41 / $5,495.41 / $5,495.41
| Facility | 22 | $5,495.41 | $5,495.41 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $2,884.03 / $2,884.03 / $2,884.03
| Facility | 62 | $2,884.03 | $2,884.03 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $7,244.36 / $16,982.44
| Facility | | $2,041.74 | $7,244.36 | $16,982.44 |