- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $4,488.89 / $10,143.29
| Facility | | $100.00 | $4,488.89 | $10,143.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,512.20 / $20,162.41 / $35,151.03
| Facility | | $8,512.20 | $20,162.41 | $35,151.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,074.84 / $3,074.84 / $3,074.84
| Facility | | $3,074.84 | $3,074.84 | $3,074.84 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $1,890.19 / $1,890.19 / $1,890.19
| Facility | 62 | $1,890.19 | $1,890.19 | $1,890.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,155.00 / $11,155.00 / $11,155.00
| Facility | | $11,155.00 | $11,155.00 | $11,155.00 |