- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,705.06 / $4,448.00 / $9,145.93
| Facility | | $2,705.06 | $4,448.00 | $9,145.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,105.25 / $16,184.00 / $28,850.83
| Facility | | $8,105.25 | $16,184.00 | $28,850.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,251.34 / $4,251.34 / $5,915.25
| Facility | | $4,251.34 | $4,251.34 | $5,915.25 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $2,621.39 / $2,621.39 / $2,621.39
| Facility | 62 | $2,621.39 | $2,621.39 | $2,621.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,403.00 / $3,325.00 / $8,198.00
| Facility | | $1,403.00 | $3,325.00 | $8,198.00 |