- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,258.00 / $3,726.00 / $7,602.00
| Facility | | $2,258.00 | $3,726.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,343.00 / $2,326.00 / $4,528.00
| Facility | | $1,343.00 | $2,326.00 | $4,528.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $21,422.17 / $22,029.70
| Facility | | $55.00 | $21,422.17 | $22,029.70 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $2,641.99 / $5,089.33 / $5,089.33
| Facility | 62 | $2,641.99 | $5,089.33 | $5,089.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,233.00 / $2,665.00 / $4,918.00
| Facility | | $1,233.00 | $2,665.00 | $4,918.00 |