- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,507.00 / $4,765.35 / $12,154.00
| Facility | | $2,507.00 | $4,765.35 | $12,154.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.00 / $4,279.00 / $9,663.00
| Facility | | $2,088.00 | $4,279.00 | $9,663.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $958.00 / $4,917.51 / $11,333.68
| Facility | | $958.00 | $4,917.51 | $11,333.68 |
- 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
- $1,185.00 / $3,233.00 / $11,343.00
| Facility | | $1,185.00 | $3,233.00 | $11,343.00 |