- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,612.65 / $4,470.00 / $12,154.00
| Facility | | $1,612.65 | $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 / $2,284.67 / $7,903.00
| Facility | | $1,120.00 | $2,284.67 | $7,903.00 |
- 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
- $1,185.00 / $3,233.00 / $11,343.00
| Facility | | $1,185.00 | $3,233.00 | $11,343.00 |