- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,166.09 / $4,526.25 / $12,174.00
| Facility | | $2,166.09 | $4,526.25 | $12,174.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,224.00 / $4,490.00 / $14,717.03
| Facility | | $2,224.00 | $4,490.00 | $14,717.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $958.00 / $4,740.00 / $11,100.46
| Facility | | $958.00 | $4,740.00 | $11,100.46 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $5,577.09 / $10,707.40 / $10,707.40
| Facility | 62 | $5,577.09 | $10,707.40 | $10,707.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,185.00 / $3,233.00 / $11,343.00
| Facility | | $1,185.00 | $3,233.00 | $11,343.00 |