- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,615.00 / $3,628.10 / $7,439.00
| Facility | | $1,615.00 | $3,628.10 | $7,439.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,628.10 / $4,587.55 / $9,588.28
| Facility | | $3,628.10 | $4,587.55 | $9,588.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,172.00 / $4,086.00 / $7,778.00
| Facility | | $1,172.00 | $4,086.00 | $7,778.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $42,218.28 / $50,145.00
| Facility | | $55.00 | $42,218.28 | $50,145.00 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $4,982.17 / $11,142.67 / $11,142.67
| Facility | 62 | $4,982.17 | $11,142.67 | $11,142.67 |