- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,293.52 / $1,615.00 / $7,439.00
| Facility | | $1,293.52 | $1,615.00 | $7,439.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,293.52 / $1,980.00 / $3,302.36
| Facility | | $1,293.52 | $1,980.00 | $3,302.36 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $361.28 / $396.00 / $680.60
| Facility | 80 | $361.28 | $396.00 | $680.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,172.00 / $4,086.00 / $7,778.00
| Facility | | $1,172.00 | $4,086.00 | $7,778.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $9,757.28 / $12,067.36
| Facility | | $55.00 | $9,757.28 | $12,067.36 |