- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $4,677.35 / $11,748.98
| Facility | | $1,737.80 | $4,677.35 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $12,589.25 / $24,547.09
| Facility | | $2,290.87 | $12,589.25 | $24,547.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $4,786.30 / $12,022.64
| Facility | | $398.11 | $4,786.30 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $602.56 / $602.56 / $602.56
| Facility | 53 | $602.56 | $602.56 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $1,905.46 / $1,905.46 / $1,905.46
| Facility | 62 | $1,905.46 | $1,905.46 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,162.28 / $10,232.93
| Facility | | $851.14 | $3,162.28 | $10,232.93 |