- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,341.58 / $4,430.50 / $8,561.00
| Facility | | $2,341.58 | $4,430.50 | $8,561.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,567.50 / $14,936.50 / $28,048.48
| Facility | | $7,567.50 | $14,936.50 | $28,048.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $887.50 / $950.00 / $3,074.84
| Facility | | $887.50 | $950.00 | $3,074.84 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $1,890.19 / $1,890.19 / $1,890.19
| Facility | 62 | $1,890.19 | $1,890.19 | $1,890.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.31 / $5,606.00 / $11,531.00
| Facility | | $2,041.31 | $5,606.00 | $11,531.00 |