- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,611.10 / $3,818.89 / $8,238.00
| Facility | | $1,611.10 | $3,818.89 | $8,238.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,105.25 / $16,184.00 / $28,925.33
| Facility | | $8,105.25 | $16,184.00 | $28,925.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,771.57 / $1,771.57 / $2,476.52
| Facility | | $1,771.57 | $1,771.57 | $2,476.52 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $1,097.49 / $1,097.49 / $1,097.49
| Facility | 62 | $1,097.49 | $1,097.49 | $1,097.49 |
- 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 |