- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,241.22 / $10,431.19 / $20,928.72
| Facility | | $4,241.22 | $10,431.19 | $20,928.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,426.81 / $12,775.74 / $23,983.33
| Facility | | $9,426.81 | $12,775.74 | $23,983.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,956.11 / $6,725.39 / $9,738.27
| Facility | | $3,956.11 | $6,725.39 | $9,738.27 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $12,811.62 / $12,811.62 / $12,811.62
| Facility | 62 | $12,811.62 | $12,811.62 | $12,811.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,072.82 / $9,855.09 / $13,311.58
| Facility | | $6,072.82 | $9,855.09 | $13,311.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,054.00 / $4,317.00 / $13,909.00
| Facility | | $3,054.00 | $4,317.00 | $13,909.00 |