- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $4,570.88 / $11,481.54
| Facility | | $676.08 | $4,570.88 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $15,488.17 / $28,840.32
| Facility | | $5,011.87 | $15,488.17 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $1,230.27 / $3,388.44
| Facility | | $34.67 | $1,230.27 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $446.68 / $446.68 / $446.68
| Facility | 62 | $446.68 | $446.68 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $1,202.26 / $3,715.35
| Facility | | $295.12 | $1,202.26 | $3,715.35 |