- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.36 / $9,062.00 / $18,276.00
| Facility | | $575.36 | $9,062.00 | $18,276.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,339.08 / $5,867.32 / $10,114.27
| Facility | | $2,339.08 | $5,867.32 | $10,114.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,208.42 / $3,208.42 / $4,122.88
| Facility | | $3,208.42 | $3,208.42 | $4,122.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $460.10 / $632.90 / $1,041.67
| Facility | | $460.10 | $632.90 | $1,041.67 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $105.60 / $126.53 / $178.60
| Facility | 80 | $105.60 | $126.53 | $178.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $791.00 / $10,257.00 / $16,249.00
| Facility | | $791.00 | $10,257.00 | $16,249.00 |