- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,900.60 / $3,389.74 / $7,602.00
| Facility | | $1,900.60 | $3,389.74 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,270.00 / $2,326.00 / $4,372.00
| Facility | | $1,270.00 | $2,326.00 | $4,372.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $21,067.08 / $21,771.12
| Facility | | $55.00 | $21,067.08 | $21,771.12 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $2,411.10 / $4,762.79 / $4,762.79
| Facility | 62 | $2,411.10 | $4,762.79 | $4,762.79 |
- 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 |