- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.81 / $2,919.19 / $7,602.00
| Facility | | $1,819.81 | $2,919.19 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,270.00 / $2,340.00 / $4,528.00
| Facility | | $1,270.00 | $2,340.00 | $4,528.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $20,604.48 / $21,130.56
| Facility | | $55.00 | $20,604.48 | $21,130.56 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $2,333.36 / $4,622.05 / $4,622.05
| Facility | 62 | $2,333.36 | $4,622.05 | $4,622.05 |
- 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 |