- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,344.76 / $3,683.00 / $18,600.00
| Facility | | $1,344.76 | $3,683.00 | $18,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,211.26 / $14,558.95 / $23,181.40
| Facility | | $9,211.26 | $14,558.95 | $23,181.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $773.00 / $1,964.41 / $5,882.00
| Facility | | $773.00 | $1,964.41 | $5,882.00 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $4,359.80 / $4,359.80 / $4,359.80
| Facility | 62 | $4,359.80 | $4,359.80 | $4,359.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $350.00 / $1,760.00 / $6,155.68
| Facility | | $350.00 | $1,760.00 | $6,155.68 |