- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,020.00 / $4,348.25 / $8,451.00
| Facility | | $1,020.00 | $4,348.25 | $8,451.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,531.00 / $27,840.00 / $46,480.74
| Facility | | $13,531.00 | $27,840.00 | $46,480.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,454.95 / $10,249.66 / $15,142.42
| Facility | | $8,454.95 | $10,249.66 | $15,142.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,013.00 / $5,342.00 / $8,451.00
| Facility | | $1,013.00 | $5,342.00 | $8,451.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,018.72 / $1,018.72 / $1,292.42
| Facility | | $1,018.72 | $1,018.72 | $1,292.42 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $1,219.75 / $1,219.75 / $1,219.75
| Facility | 62 | $1,219.75 | $1,219.75 | $1,219.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $625.00 / $2,391.00 / $6,322.00
| Facility | | $625.00 | $2,391.00 | $6,322.00 |