- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.20 / $2,332.63 / $7,114.44
| Facility | | $1,479.20 | $2,332.63 | $7,114.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.20 / $1,908.06 / $3,010.07
| Facility | | $1,479.20 | $1,908.06 | $3,010.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,172.00 / $4,086.00 / $7,778.00
| Facility | | $1,172.00 | $4,086.00 | $7,778.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $17,106.48 / $20,604.48
| Facility | | $55.00 | $17,106.48 | $20,604.48 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $2,076.85 / $4,622.05 / $4,622.05
| Facility | 62 | $2,076.85 | $4,622.05 | $4,622.05 |