- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $460.10 / $1,635.00 / $10,561.00
| Facility | | $460.10 | $1,635.00 | $10,561.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $460.10 / $641.54 / $1,174.31
| Facility | | $460.10 | $641.54 | $1,174.31 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $111.20 / $128.31 / $234.86
| Facility | 80 | $111.20 | $128.31 | $234.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,526.00 / $7,659.00 / $10,502.00
| Facility | | $2,526.00 | $7,659.00 | $10,502.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,628.72 / $14,302.50 / $26,542.00
| Facility | | $2,628.72 | $14,302.50 | $26,542.00 |