- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,652.00 / $4,069.00 / $7,602.00
| Facility | | $2,652.00 | $4,069.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,031.00 / $2,226.00 / $4,232.00
| Facility | | $1,031.00 | $2,226.00 | $4,232.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $500.00 / $525.00 / $2,530.00
| Facility | | $500.00 | $525.00 | $2,530.00 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $2,244.61 / $2,244.61 / $2,244.61
| Facility | 62 | $2,244.61 | $2,244.61 | $2,244.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $57,710.40 / $59,160.16
| Facility | | $55.00 | $57,710.40 | $59,160.16 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $4,453.45 / $9,562.91 / $9,562.91
| Facility | 62 | $4,453.45 | $9,562.91 | $9,562.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $875.00 / $2,397.00 / $4,544.00
| Facility | | $875.00 | $2,397.00 | $4,544.00 |