- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,200.00 / $3,779.00 / $12,600.00
| Facility | | $1,200.00 | $3,779.00 | $12,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,374.38 / $8,476.95 / $13,489.91
| Facility | | $5,374.38 | $8,476.95 | $13,489.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,515.00 / $2,741.47 / $5,690.67
| Facility | | $1,515.00 | $2,741.47 | $5,690.67 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $6,477.24 / $6,477.24 / $6,477.24
| Facility | 62 | $6,477.24 | $6,477.24 | $6,477.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $880.00 / $2,900.00 / $5,543.93
| Facility | | $880.00 | $2,900.00 | $5,543.93 |