- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,615.00 / $2,114.66 / $7,439.00
| Facility | | $1,615.00 | $2,114.66 | $7,439.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,882.56 / $2,642.64 / $4,748.28
| Facility | | $1,882.56 | $2,642.64 | $4,748.28 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $464.40 / $528.53 / $949.66
| Facility | 80 | $464.40 | $528.53 | $949.66 |
- 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 / $15,899.04 / $19,655.91
| Facility | | $55.00 | $15,899.04 | $19,655.91 |