- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,277.00 / $5,549.00 / $11,100.08
| Facility | | $4,277.00 | $5,549.00 | $11,100.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,427.54 / $2,471.03 / $4,187.72
| Professional | | $1,427.54 | $2,471.03 | $4,187.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,207.11 / $3,604.50 / $6,608.00
| Facility | | $2,207.11 | $3,604.50 | $6,608.00 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $4,433.60 / $4,433.60 / $4,433.60
| Facility | 62 | $4,433.60 | $4,433.60 | $4,433.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,370.08 / $3,530.24 / $4,617.33
| Facility | | $2,370.08 | $3,530.24 | $4,617.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,126.00 / $5,847.00 / $7,305.00
| Facility | | $2,126.00 | $5,847.00 | $7,305.00 |