- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,819.70 / $9,772.37
| Facility | | $1,348.96 | $1,819.70 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $4,677.35 / $6,309.57
| Facility | | $3,467.37 | $4,677.35 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $7,413.10 / $7,413.10
| Facility | | $7,413.10 | $7,413.10 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $7,413.10 / $7,413.10
| Facility | | $7,413.10 | $7,413.10 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $263.03 / $416.87
| Facility | | $263.03 | $263.03 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $151.36 / $151.36 / $151.36
| Facility | 62 | $151.36 | $151.36 | $151.36 |