- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,615.00 / $4,215.75 / $10,561.00
| Facility | | $1,615.00 | $4,215.75 | $10,561.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $606.10
| Facility | | $606.10 | $606.10 | $606.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,658.35 / $3,730.00 / $6,007.87
| Facility | | $2,658.35 | $3,730.00 | $6,007.87 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $707.06 / $746.00 / $1,254.74
| Facility | 80 | $707.06 | $746.00 | $1,254.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,183.00 / $12,216.00 / $19,066.00
| Facility | | $3,183.00 | $12,216.00 | $19,066.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,000.00 / $27,703.08 / $27,703.08
| Facility | | $2,000.00 | $27,703.08 | $27,703.08 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $2,366.38 / $4,307.78 / $8,335.36
| Facility | 62 | $2,366.38 | $4,307.78 | $8,335.36 |