- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,338.00 / $3,494.30 / $8,413.00
| Facility | | $1,338.00 | $3,494.30 | $8,413.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,224.76 / $2,803.20 / $3,923.37
| Facility | | $2,224.76 | $2,803.20 | $3,923.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,526.00 / $7,659.00 / $10,502.00
| Facility | | $2,526.00 | $7,659.00 | $10,502.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,000.00 / $10,398.29 / $12,811.25
| Facility | | $2,000.00 | $10,398.29 | $12,811.25 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $3,188.38 / $3,582.16 / $6,951.51
| Facility | 62 | $3,188.38 | $3,582.16 | $6,951.51 |