- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,153.83 / $4,470.00 / $12,154.00
| Facility | | $1,153.83 | $4,470.00 | $12,154.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,224.00 / $4,490.00 / $13,193.24
| Facility | | $2,224.00 | $4,490.00 | $13,193.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $835.44 / $1,671.73 / $7,903.00
| Facility | | $835.44 | $1,671.73 | $7,903.00 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $1,684.61 / $3,220.63 / $3,220.63
| Facility | 62 | $1,684.61 | $3,220.63 | $3,220.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,185.00 / $3,233.00 / $11,343.00
| Facility | | $1,185.00 | $3,233.00 | $11,343.00 |