- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,882.62 / $8,817.20 / $16,467.00
| Facility | | $3,882.62 | $8,817.20 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $560.00 / $615.00
| Facility | | $100.00 | $560.00 | $615.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,079.12 / $3,995.00 / $6,651.08
| Facility | | $3,079.12 | $3,995.00 | $6,651.08 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $628.40 / $799.00 / $1,196.61
| Facility | 80 | $628.40 | $799.00 | $1,196.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $454.00 / $6,074.00 / $8,818.00
| Facility | | $454.00 | $6,074.00 | $8,818.00 |