- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,705.06 / $4,391.50 / $8,257.83
| Facility | | $2,705.06 | $4,391.50 | $8,257.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,105.25 / $16,184.00 / $30,036.52
| Facility | | $8,105.25 | $16,184.00 | $30,036.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,797.86 / $3,797.86 / $5,318.47
| Facility | | $3,797.86 | $3,797.86 | $5,318.47 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $2,356.92 / $2,356.92 / $2,356.92
| Facility | 62 | $2,356.92 | $2,356.92 | $2,356.92 |
- 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 |