- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,864.43 / $3,325.22 / $7,602.00
| Facility | | $1,864.43 | $3,325.22 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,275.00 / $2,326.00 / $4,528.00
| Facility | | $1,275.00 | $2,326.00 | $4,528.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $21,241.20 / $21,765.00
| Facility | | $55.00 | $21,241.20 | $21,765.00 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $2,377.38 / $4,748.78 / $4,748.78
| Facility | 62 | $2,377.38 | $4,748.78 | $4,748.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,200.00 / $2,665.00 / $4,918.00
| Facility | | $1,200.00 | $2,665.00 | $4,918.00 |