- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $4,570.88 / $10,964.78
| Facility | | $1,659.59 | $4,570.88 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $9,120.11 / $16,982.44
| Facility | | $3,388.44 | $9,120.11 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $6,760.83 / $19,498.45
| Facility | | $34.67 | $6,760.83 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $2,398.83 / $2,398.83 / $2,398.83
| Facility | 62 | $2,398.83 | $2,398.83 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $3,981.07 / $9,549.93
| Facility | | $1,288.25 | $3,981.07 | $9,549.93 |