- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,318.00 / $3,394.86 / $4,846.00
| Facility | | $2,318.00 | $3,394.86 | $4,846.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,838.00 / $16,821.03 / $25,253.12
| Facility | | $4,838.00 | $16,821.03 | $25,253.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,829.05 / $3,677.77 / $4,243.58
| Facility | | $2,829.05 | $3,677.77 | $4,243.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $761.00 / $761.00 / $3,677.58
| Facility | | $761.00 | $761.00 | $3,677.58 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $2,244.61 / $2,244.61 / $2,244.61
| Facility | 62 | $2,244.61 | $2,244.61 | $2,244.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $612.00 / $5,076.00 / $10,396.00
| Facility | | $612.00 | $5,076.00 | $10,396.00 |