- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,487.51 / $8,783.00 / $16,639.00
| Facility | | $2,487.51 | $8,783.00 | $16,639.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.00 / $580.00 / $580.00
| Facility | | $580.00 | $580.00 | $580.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,138.39 / $2,736.26 / $3,534.27
| Facility | | $2,138.39 | $2,736.26 | $3,534.27 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $473.60 / $588.50 / $664.60
| Facility | 80 | $473.60 | $588.50 | $664.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $791.00 / $10,257.00 / $16,249.00
| Facility | | $791.00 | $10,257.00 | $16,249.00 |