- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,688.54 / $4,328.50 / $7,940.20
| Facility | | $2,688.54 | $4,328.50 | $7,940.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,838.00 / $11,780.00 / $23,711.32
| Facility | | $4,838.00 | $11,780.00 | $23,711.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $680.00 / $870.49 / $3,677.58
| Facility | | $680.00 | $870.49 | $3,677.58 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $2,244.61 / $2,244.61 / $2,244.61
| Facility | 62 | $2,244.61 | $2,244.61 | $2,244.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $718.00 / $2,575.00 / $7,326.50
| Facility | | $718.00 | $2,575.00 | $7,326.50 |