- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,141.38 / $3,650.50 / $8,074.63
| Facility | | $1,141.38 | $3,650.50 | $8,074.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,195.00 / $10,939.79 / $24,013.93
| Facility | | $5,195.00 | $10,939.79 | $24,013.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,277.76 / $1,277.76 / $1,789.30
| Facility | | $1,277.76 | $1,277.76 | $1,789.30 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $792.94 / $792.94 / $792.94
| Facility | 62 | $792.94 | $792.94 | $792.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,292.00 / $3,325.00 / $8,198.00
| Facility | | $1,292.00 | $3,325.00 | $8,198.00 |