- 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
- $1,233.59 / $4,605.95 / $8,070.83
| Facility | | $1,233.59 | $4,605.95 | $8,070.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,215.22 / $5,623.71 / $10,131.12
| Facility | | $4,215.22 | $5,623.71 | $10,131.12 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $8,283.79 / $15,385.09 / $15,385.09
| Facility | 62 | $8,283.79 | $15,385.09 | $15,385.09 |
- 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 |