- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,821.00 / $3,940.00 / $7,602.00
| Facility | | $1,821.00 | $3,940.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,695.00 / $5,486.00 / $9,272.00
| Facility | | $2,695.00 | $5,486.00 | $9,272.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.00 / $30.00 / $30.00
| Facility | | $30.00 | $30.00 | $30.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,000.00 / $27,703.08 / $28,425.69
| Facility | | $2,000.00 | $27,703.08 | $28,425.69 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $4,307.78 / $8,335.36 / $8,335.36
| Facility | 62 | $4,307.78 | $8,335.36 | $8,335.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,799.00 / $5,709.00 / $10,111.00
| Facility | | $2,799.00 | $5,709.00 | $10,111.00 |