- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $8,511.38 / $13,803.84
| Facility | | $4,466.84 | $8,511.38 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $17,378.01 / $17,378.01 / $17,378.01
| Facility | 62 | $17,378.01 | $17,378.01 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $2,951.21 / $2,951.21
| Facility | | $2,951.21 | $2,951.21 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,877.62 / $33,884.42 / $52,480.75
| Facility | | $21,877.62 | $33,884.42 | $52,480.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $9,772.37 / $25,118.86
| Facility | | $4,466.84 | $9,772.37 | $25,118.86 |