- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $3,890.45 / $7,762.47
| Facility | | $2,089.30 | $3,890.45 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $5,370.32 / $7,943.28
| Facility | | $1,659.59 | $5,370.32 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,754.23 / $5,128.61
| Facility | | $2,089.30 | $2,754.23 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $3,630.78 / $3,630.78 / $6,456.54
| Facility | 62 | $3,630.78 | $3,630.78 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $3,311.31 / $5,370.32
| Facility | | $1,288.25 | $3,311.31 | $5,370.32 |