- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,687.94 / $2,687.94 / $6,575.00
| Facility | | $2,687.94 | $2,687.94 | $6,575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,206.67 / $10,679.43 / $21,735.40
| Facility | | $4,206.67 | $10,679.43 | $21,735.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,485.46 / $9,201.93 / $22,136.48
| Facility | | $6,485.46 | $9,201.93 | $22,136.48 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $1,890.19 / $1,890.19 / $1,890.19
| Facility | 62 | $1,890.19 | $1,890.19 | $1,890.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,895.87 / $8,412.77 / $17,430.30
| Facility | | $5,895.87 | $8,412.77 | $17,430.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,741.29 / $4,502.66 / $7,504.44
| Facility | | $2,741.29 | $4,502.66 | $7,504.44 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $4,307.78 / $4,307.78 / $4,307.78
| Facility | 62 | $4,307.78 | $4,307.78 | $4,307.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,670.17 / $5,331.00 / $11,531.00
| Facility | | $1,670.17 | $5,331.00 | $11,531.00 |