- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,400.00 / $2,677.40 / $4,117.33
| Facility | | $1,400.00 | $2,677.40 | $4,117.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,657.14 / $2,863.90 / $3,474.00
| Facility | | $2,657.14 | $2,863.90 | $3,474.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,074.84 / $3,074.84 / $3,074.84
| Facility | | $3,074.84 | $3,074.84 | $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
- $1,670.17 / $1,670.17 / $1,670.17
| Facility | | $1,670.17 | $1,670.17 | $1,670.17 |