- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $2,454.71 / $6,456.54
| Facility | | $891.25 | $2,454.71 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $2,454.71 / $4,365.16
| Facility | | $1,348.96 | $2,454.71 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $14,125.38 / $14,125.38
| Facility | | $1,995.26 | $14,125.38 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $8,912.51 / $8,912.51 / $8,912.51
| Facility | 62 | $8,912.51 | $8,912.51 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $3,630.78 / $6,309.57
| Facility | | $2,041.74 | $3,630.78 | $6,309.57 |