- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $4,570.88 / $11,481.54
| Facility | | $1,584.89 | $4,570.88 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $13,803.84 / $28,183.83
| Facility | | $4,677.35 | $13,803.84 | $28,183.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $4,570.88 / $13,182.57
| Facility | | $323.59 | $4,570.88 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $1,659.59 / $1,659.59 / $1,659.59
| Facility | 62 | $1,659.59 | $1,659.59 | $1,659.59 |
- 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 |