- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $2,818.38 / $8,511.38
| Facility | | $851.14 | $2,818.38 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $10,715.19 / $11,220.18
| Facility | | $5,888.44 | $10,715.19 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,238.72 / $2,630.27
| Facility | | $1,548.82 | $2,238.72 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $3,019.95 / $3,019.95
| Facility | | $34.67 | $3,019.95 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $1,862.09 / $1,862.09 / $1,862.09
| Facility | 62 | $1,862.09 | $1,862.09 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $4,466.84 / $30,199.52
| Facility | | $602.56 | $4,466.84 | $30,199.52 |