- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $4,466.84 / $20,892.96
| Facility | | $2,398.83 | $4,466.84 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,542.29 / $30,902.95 / $36,307.81
| Facility | | $27,542.29 | $30,902.95 | $36,307.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,589.25 / $12,589.25 / $12,589.25
| Facility | | $12,589.25 | $12,589.25 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,589.25 / $12,589.25 / $12,589.25
| Facility | | $12,589.25 | $12,589.25 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $977.24 / $1,548.82
| Facility | | $977.24 | $977.24 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $562.34 / $562.34 / $562.34
| Facility | 62 | $562.34 | $562.34 | $562.34 |