- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,743.84 / $10,431.19 / $20,928.72
| Facility | | $4,743.84 | $10,431.19 | $20,928.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,426.81 / $13,666.22 / $23,983.33
| Facility | | $9,426.81 | $13,666.22 | $23,983.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,743.84 / $7,827.34 / $11,073.96
| Facility | | $4,743.84 | $7,827.34 | $11,073.96 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $15,385.09 / $15,385.09 / $15,385.09
| Facility | 62 | $15,385.09 | $15,385.09 | $15,385.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,995.62 / $11,495.68 / $15,768.51
| Facility | | $7,995.62 | $11,495.68 | $15,768.51 |
- 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 |