- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $4,466.84 / $20,892.96
| Facility | | $2,187.76 | $4,466.84 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $63,095.73 / $77,624.71 / $87,096.36
| Facility | | $63,095.73 | $77,624.71 | $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
- $1,348.96 / $1,348.96 / $2,137.96
| Facility | | $1,348.96 | $1,348.96 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $776.25 / $776.25 / $776.25
| Facility | 62 | $776.25 | $776.25 | $776.25 |