- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,565.32 / $3,740.49 / $8,074.63
| Facility | | $1,565.32 | $3,740.49 | $8,074.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,105.25 / $16,184.00 / $28,850.83
| Facility | | $8,105.25 | $16,184.00 | $28,850.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,795.20 / $1,795.20 / $2,504.39
| Facility | | $1,795.20 | $1,795.20 | $2,504.39 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $1,109.83 / $1,109.83 / $1,109.83
| Facility | 62 | $1,109.83 | $1,109.83 | $1,109.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,403.00 / $3,325.00 / $8,198.00
| Facility | | $1,403.00 | $3,325.00 | $8,198.00 |