- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,671.00 / $3,617.00 / $6,329.00
| Facility | | $1,671.00 | $3,617.00 | $6,329.00 |
- 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
- $1,437.77 / $1,823.70 / $4,276.00
| Facility | | $1,437.77 | $1,823.70 | $4,276.00 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $2,411.10 / $4,433.60 / $4,433.60
| Facility | 62 | $2,411.10 | $4,433.60 | $4,433.60 |
- 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 |