- 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
- $1,417.00 / $2,387.00 / $6,245.00
| Facility | | $1,417.00 | $2,387.00 | $6,245.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $27,284.51 / $27,992.36
| Facility | | $55.00 | $27,284.51 | $27,992.36 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $3,358.39 / $6,458.54 / $6,458.54
| Facility | 62 | $3,358.39 | $6,458.54 | $6,458.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,200.00 / $2,486.00 / $4,918.00
| Facility | | $1,200.00 | $2,486.00 | $4,918.00 |