- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,958.56 / $4,421.50 / $8,181.00
| Facility | | $1,958.56 | $4,421.50 | $8,181.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,048.19 / $9,469.49 / $15,034.94
| Facility | | $4,048.19 | $9,469.49 | $15,034.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,322.76 / $2,580.13 / $2,580.13
| Facility | | $2,322.76 | $2,580.13 | $2,580.13 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $1,589.61 / $1,589.61 / $1,589.61
| Facility | 62 | $1,589.61 | $1,589.61 | $1,589.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,967.50 / $4,044.50 / $8,138.00
| Facility | | $1,967.50 | $4,044.50 | $8,138.00 |