- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $3,467.37 / $6,760.83
| Facility | | $1,202.26 | $3,467.37 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $7,943.28 / $12,882.50
| Facility | | $5,128.61 | $7,943.28 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,754.23 / $5,888.44
| Facility | | $1,380.38 | $2,754.23 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $6,456.54 / $6,456.54 / $6,456.54
| Facility | 62 | $6,456.54 | $6,456.54 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $2,951.21 / $5,888.44
| Facility | | $891.25 | $2,951.21 | $5,888.44 |