- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $3,548.13 / $7,943.28
| Facility | | $1,778.28 | $3,548.13 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,786.30 / $10,000.00
| Facility | | $2,238.72 | $4,786.30 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,691.53 / $6,309.57
| Facility | | $1,698.24 | $2,691.53 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $3,630.78 / $6,456.54 / $6,456.54
| Facility | 62 | $3,630.78 | $6,456.54 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $2,398.83 / $4,073.80
| Facility | | $1,288.25 | $2,398.83 | $4,073.80 |