- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,671.00 / $3,617.00 / $7,562.14
| Facility | | $1,671.00 | $3,617.00 | $7,562.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,763.75 / $6,598.50 / $10,860.55
| Facility | | $1,763.75 | $6,598.50 | $10,860.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,132.00 / $4,951.43 / $9,396.43
| Facility | | $2,132.00 | $4,951.43 | $9,396.43 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $7,252.56 / $13,541.08 / $13,541.08
| Facility | 62 | $7,252.56 | $13,541.08 | $13,541.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,424.00 / $3,269.00 / $14,572.00
| Facility | | $1,424.00 | $3,269.00 | $14,572.00 |