- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $3,890.45 / $7,762.47
| Facility | | $1,445.44 | $3,890.45 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $891.25 / $891.25
| Facility | | $891.25 | $891.25 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $3,890.45 / $8,912.51
| Facility | | $1,995.26 | $3,890.45 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $4,265.80 / $7,762.47 / $7,762.47
| Facility | 62 | $4,265.80 | $7,762.47 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $5,754.40 / $10,715.19
| Facility | | $1,621.81 | $5,754.40 | $10,715.19 |