- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $2,630.27 / $8,511.38
| Facility | | $794.33 | $2,630.27 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $10,715.19 / $11,220.18
| Facility | | $6,606.93 | $10,715.19 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,570.40 / $3,388.44
| Facility | | $2,041.74 | $2,570.40 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $3,890.45 / $3,890.45
| Facility | | $34.67 | $3,890.45 | $3,890.45 |
- 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
- $602.56 / $1,949.84 / $6,309.57
| Facility | | $602.56 | $1,949.84 | $6,309.57 |