- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,250.26 / $4,933.00 / $10,458.00
| Facility | | $2,250.26 | $4,933.00 | $10,458.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,977.00 / $18,969.71 / $42,671.63
| Facility | | $6,977.00 | $18,969.71 | $42,671.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,565.42 / $2,565.42 / $5,361.44
| Facility | | $2,565.42 | $2,565.42 | $5,361.44 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $1,548.83 / $1,548.83 / $1,548.83
| Facility | 62 | $1,548.83 | $1,548.83 | $1,548.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,283.50 / $3,324.00 / $8,175.00
| Facility | | $1,283.50 | $3,324.00 | $8,175.00 |