- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $5,370.32 / $12,589.25
| Facility | | $1,819.70 | $5,370.32 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $13,489.63 / $28,183.83
| Facility | | $4,677.35 | $13,489.63 | $28,183.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $10,471.29 / $29,512.09
| Facility | | $323.59 | $10,471.29 | $29,512.09 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $3,981.07 / $3,981.07 / $3,981.07
| Facility | 62 | $3,981.07 | $3,981.07 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,162.28 / $10,232.93
| Facility | | $851.14 | $3,162.28 | $10,232.93 |