- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,671.00 / $3,819.00 / $7,960.15
| Facility | | $1,671.00 | $3,819.00 | $7,960.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,763.75 / $6,598.50 / $10,860.55
| Facility | | $1,763.75 | $6,598.50 | $10,860.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,132.00 / $3,458.71 / $6,162.79
| Facility | | $2,132.00 | $3,458.71 | $6,162.79 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $5,004.00 / $9,516.21 / $9,516.21
| Facility | 62 | $5,004.00 | $9,516.21 | $9,516.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,424.00 / $3,269.00 / $14,572.00
| Facility | | $1,424.00 | $3,269.00 | $14,572.00 |