- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,965.00 / $4,474.00 / $7,960.15
| Facility | | $1,965.00 | $4,474.00 | $7,960.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,763.75 / $6,640.00 / $10,860.55
| Facility | | $1,763.75 | $6,640.00 | $10,860.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,575.29 / $3,491.00 / $7,168.00
| Facility | | $2,575.29 | $3,491.00 | $7,168.00 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $4,307.78 / $4,307.78 / $7,694.91
| Facility | 62 | $4,307.78 | $4,307.78 | $7,694.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,759.00 / $6,477.00 / $9,010.00
| Facility | | $4,759.00 | $6,477.00 | $9,010.00 |