- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $525.65 / $4,610.00 / $12,154.00
| Facility | | $525.65 | $4,610.00 | $12,154.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.00 / $4,247.00 / $9,663.00
| Facility | | $2,088.00 | $4,247.00 | $9,663.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $669.68 / $1,289.00
| Facility | | $55.00 | $669.68 | $1,289.00 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $632.28 / $1,174.16 / $1,174.16
| Facility | 62 | $632.28 | $1,174.16 | $1,174.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.00 / $760.00 / $1,300.00
| Facility | | $245.00 | $760.00 | $1,300.00 |