- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,962.05 / $7,155.00 / $11,679.00
| Facility | | $1,962.05 | $7,155.00 | $11,679.00 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $1,085.45 / $1,085.45 / $1,085.45
| Facility | 80 | $1,085.45 | $1,085.45 | $1,085.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,097.00 / $8,010.00 / $36,529.00
| Facility | | $2,097.00 | $8,010.00 | $36,529.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,706.22 / $1,706.22 / $2,484.48
| Facility | | $1,706.22 | $1,706.22 | $2,484.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,571.00 / $21,571.00 / $21,571.00
| Facility | | $21,571.00 | $21,571.00 | $21,571.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,480.00 / $3,086.00 / $6,792.00
| Facility | | $1,480.00 | $3,086.00 | $6,792.00 |