- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $5,248.07 / $8,511.38
| Facility | | $2,511.89 | $5,248.07 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,677.35 / $8,912.51
| Facility | | $2,238.72 | $4,677.35 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $6,309.57 / $12,022.64
| Facility | | $2,238.72 | $6,309.57 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $8,317.64 / $15,488.17 / $15,488.17
| Facility | 62 | $8,317.64 | $15,488.17 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $2,818.38 / $10,471.29
| Facility | | $1,230.27 | $2,818.38 | $10,471.29 |