- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,635.00 / $2,800.00 / $7,602.00
| Facility | | $1,635.00 | $2,800.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,375.00 / $2,344.00 / $4,232.00
| Facility | | $1,375.00 | $2,344.00 | $4,232.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,000.00 / $15,523.68 / $15,913.20
| Facility | | $2,000.00 | $15,523.68 | $15,913.20 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $3,611.56 / $7,019.94 / $7,019.94
| Facility | 62 | $3,611.56 | $7,019.94 | $7,019.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,794.00 / $3,616.00 / $6,003.00
| Facility | | $1,794.00 | $3,616.00 | $6,003.00 |