- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $4,365.16 / $20,892.96
| Facility | | $2,398.83 | $4,365.16 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,840.32 / $70,794.58 / $87,096.36
| Facility | | $28,840.32 | $70,794.58 | $87,096.36 |
- 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
- $954.99 / $954.99 / $1,513.56
| Facility | | $954.99 | $954.99 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $549.54 / $549.54 / $549.54
| Facility | 62 | $549.54 | $549.54 | $549.54 |