- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,760.00 / $5,389.00 / $12,154.00
| Facility | | $1,760.00 | $5,389.00 | $12,154.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,224.00 / $4,490.00 / $14,717.03
| Facility | | $2,224.00 | $4,490.00 | $14,717.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,043.74 / $3,802.13 / $6,661.33
| Facility | | $2,043.74 | $3,802.13 | $6,661.33 |
- 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
- $1,855.74 / $4,000.00 / $9,817.00
| Facility | | $1,855.74 | $4,000.00 | $9,817.00 |