- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,760.00 / $4,470.00 / $8,000.00
| Facility | | $1,760.00 | $4,470.00 | $8,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,224.00 / $4,490.00 / $10,156.00
| Facility | | $2,224.00 | $4,490.00 | $10,156.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,677.84 / $2,680.00 / $6,666.61
| Facility | | $1,677.84 | $2,680.00 | $6,666.61 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $3,611.56 / $3,611.56 / $6,477.24
| Facility | 62 | $3,611.56 | $3,611.56 | $6,477.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,644.00 / $2,874.00 / $5,813.00
| Facility | | $1,644.00 | $2,874.00 | $5,813.00 |