- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,070.00 / $3,617.00 / $6,329.00
| Facility | | $1,070.00 | $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
- $1,385.80 / $1,735.18 / $4,172.00
| Facility | | $1,385.80 | $1,735.18 | $4,172.00 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $2,333.36 / $4,359.80 / $4,359.80
| Facility | 62 | $2,333.36 | $4,359.80 | $4,359.80 |
- 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 |