- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,965.00 / $3,819.00 / $7,467.00
| Facility | | $1,965.00 | $3,819.00 | $7,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,763.75 / $6,855.80 / $10,860.55
| Facility | | $1,763.75 | $6,855.80 | $10,860.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,087.44 / $2,572.60 / $4,408.02
| Facility | | $2,087.44 | $2,572.60 | $4,408.02 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $3,582.16 / $3,582.16 / $6,409.11
| Facility | 62 | $3,582.16 | $3,582.16 | $6,409.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,343.00 / $3,339.00 / $5,838.00
| Facility | | $2,343.00 | $3,339.00 | $5,838.00 |