- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,907.94 / $6,608.22 / $16,467.00
| Facility | | $2,907.94 | $6,608.22 | $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
- $1,907.00 / $2,758.60 / $4,943.50
| Facility | | $1,907.00 | $2,758.60 | $4,943.50 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $381.40 / $445.20 / $896.83
| Facility | 80 | $381.40 | $445.20 | $896.83 |
- 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 |