- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,454.71 / $8,709.64
| Facility | | $1,513.56 | $2,454.71 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,089.30 / $3,311.31
| Facility | | $1,513.56 | $2,089.30 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $3,890.45 / $6,918.31
| Facility | | $1,174.90 | $3,890.45 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $21,379.62 / $21,379.62
| Facility | | $56.23 | $21,379.62 | $21,379.62 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $13,182.57 / $13,182.57 / $13,182.57
| Facility | 62 | $13,182.57 | $13,182.57 | $13,182.57 |