- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $817.66 / $2,678.00 / $7,602.00
| Facility | | $817.66 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $108.00 / $148.00 / $1,676.00
| Facility | | $108.00 | $148.00 | $1,676.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,878.65 / $1,952.06
| Facility | | $55.00 | $1,878.65 | $1,952.06 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $632.28 / $1,220.04 / $1,220.04
| Facility | 62 | $632.28 | $1,220.04 | $1,220.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.00 / $794.00 / $2,577.00
| Facility | | $294.00 | $794.00 | $2,577.00 |