- 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
- $10,176.85 / $13,792.24 / $25,891.56
| Facility | | $10,176.85 | $13,792.24 | $25,891.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,521.19 / $2,446.85 / $7,856.00
| Facility | | $1,521.19 | $2,446.85 | $7,856.00 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $4,433.60 / $4,433.60 / $4,433.60
| Facility | 62 | $4,433.60 | $4,433.60 | $4,433.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,799.97 / $3,479.58 / $4,870.03
| Facility | | $2,799.97 | $3,479.58 | $4,870.03 |
- 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 |