- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,117.20 / $9,062.00 / $18,276.00
| Facility | | $3,117.20 | $9,062.00 | $18,276.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,783.09 / $10,824.58 / $17,240.66
| Facility | | $4,783.09 | $10,824.58 | $17,240.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $715.00 / $890.00 / $3,074.84
| Facility | | $715.00 | $890.00 | $3,074.84 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $1,890.19 / $1,890.19 / $1,890.19
| Facility | 62 | $1,890.19 | $1,890.19 | $1,890.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,117.20 / $3,797.37 / $6,034.99
| Facility | | $3,117.20 | $3,797.37 | $6,034.99 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $694.68 / $841.80 / $1,187.02
| Facility | 80 | $694.68 | $841.80 | $1,187.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,855.74 / $15,713.00 / $23,485.00
| Facility | | $1,855.74 | $15,713.00 | $23,485.00 |