- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,964.00 / $6,066.00 / $7,119.04
| Facility | | $4,964.00 | $6,066.00 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,986.88 / $4,196.18 / $8,368.40
| Professional | | $2,986.88 | $4,196.18 | $8,368.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,251.40 / $5,244.00 / $7,811.37
| Facility | | $3,251.40 | $5,244.00 | $7,811.37 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $9,144.40 / $9,144.40 / $9,144.40
| Facility | 62 | $9,144.40 | $9,144.40 | $9,144.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,677.37 / $6,238.14 / $9,502.17
| Facility | | $3,677.37 | $6,238.14 | $9,502.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,321.00 / $5,847.00 / $7,856.00
| Facility | | $1,321.00 | $5,847.00 | $7,856.00 |