- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,671.00 / $4,474.00 / $7,960.15
| Facility | | $1,671.00 | $4,474.00 | $7,960.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,660.00 / $6,198.03 / $10,860.55
| Facility | | $1,660.00 | $6,198.03 | $10,860.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,453.00 / $3,343.65 / $5,957.77
| Facility | | $2,453.00 | $3,343.65 | $5,957.77 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $4,913.04 / $9,144.40 / $9,144.40
| Facility | 62 | $4,913.04 | $9,144.40 | $9,144.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $175.00 / $2,572.00 / $14,572.00
| Facility | | $175.00 | $2,572.00 | $14,572.00 |