- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $5,011.87 / $7,762.47
| Facility | | $3,388.44 | $5,011.87 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $5,495.41 / $5,495.41
| Facility | | $5,495.41 | $5,495.41 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $3,467.37 / $3,467.37 / $3,467.37
| Facility | 62 | $3,467.37 | $3,467.37 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $3,548.13 / $5,888.44
| Facility | | $2,754.23 | $3,548.13 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $5,011.87 / $17,782.79
| Facility | | $562.34 | $5,011.87 | $17,782.79 |