- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,805.50 / $8,644.61 / $16,467.00
| Facility | | $3,805.50 | $8,644.61 | $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
- $2,252.00 / $3,714.62 / $6,463.85
| Facility | | $2,252.00 | $3,714.62 | $6,463.85 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $450.40 / $533.20 / $1,173.20
| Facility | 80 | $450.40 | $533.20 | $1,173.20 |
- 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 |