- 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
- $8,461.16 / $11,467.05 / $21,526.57
| Facility | | $8,461.16 | $11,467.05 | $21,526.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,620.54 / $5,552.02 / $8,265.84
| Facility | | $3,620.54 | $5,552.02 | $8,265.84 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $10,707.40 / $10,707.40 / $10,707.40
| Facility | 62 | $10,707.40 | $10,707.40 | $10,707.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,422.34 / $8,236.45 / $11,559.82
| Facility | | $6,422.34 | $8,236.45 | $11,559.82 |
- 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 |