- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $4,677.35 / $11,748.98
| Facility | | $1,513.56 | $4,677.35 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $13,489.63 / $28,183.83
| Facility | | $4,677.35 | $13,489.63 | $28,183.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $3,715.35 / $10,471.29
| Facility | | $398.11 | $3,715.35 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $3,090.30 / $3,090.30 / $3,090.30
| Facility | 22 | $3,090.30 | $3,090.30 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $1,621.81 / $1,621.81 / $1,621.81
| Facility | 62 | $1,621.81 | $1,621.81 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,162.28 / $10,232.93
| Facility | | $851.14 | $3,162.28 | $10,232.93 |