- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $518.31 / $3,606.50 / $8,373.50
| Facility | | $518.31 | $3,606.50 | $8,373.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,233.00 / $7,875.00 / $9,663.00
| Facility | | $3,233.00 | $7,875.00 | $9,663.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $650.94 / $650.94 / $908.00
| Facility | | $650.94 | $650.94 | $908.00 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $288.47 / $288.47 / $288.47
| Facility | 62 | $288.47 | $288.47 | $288.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $444.00 / $1,221.00 / $2,883.00
| Facility | | $444.00 | $1,221.00 | $2,883.00 |