- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,671.00 / $3,617.00 / $6,329.00
| Facility | | $1,671.00 | $3,617.00 | $6,329.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,763.75 / $6,598.50 / $10,860.55
| Facility | | $1,763.75 | $6,598.50 | $10,860.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,132.00 / $4,684.66 / $8,828.57
| Facility | | $2,132.00 | $4,684.66 | $8,828.57 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $6,864.78 / $12,811.62 / $12,811.62
| Facility | 62 | $6,864.78 | $12,811.62 | $12,811.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,424.00 / $3,269.00 / $14,572.00
| Facility | | $1,424.00 | $3,269.00 | $14,572.00 |