- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,619.41 / $4,470.00 / $12,154.00
| Facility | | $1,619.41 | $4,470.00 | $12,154.00 |
- 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
- $1,120.00 / $2,314.62 / $7,903.00
| Facility | | $1,120.00 | $2,314.62 | $7,903.00 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $2,377.38 / $4,521.58 / $4,521.58
| Facility | 62 | $2,377.38 | $4,521.58 | $4,521.58 |
- 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 |