- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,067.41 / $8,960.00 / $16,467.00
| Facility | | $1,067.41 | $8,960.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,626.67 / $10,626.67 / $10,626.67
| Facility | | $10,626.67 | $10,626.67 | $10,626.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $914.49 / $1,249.00 / $2,079.54
| Facility | | $914.49 | $1,249.00 | $2,079.54 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $242.07 / $250.23 / $347.86
| Facility | 80 | $242.07 | $250.23 | $347.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,444.40 / $9,904.00 / $16,772.00
| Facility | | $2,444.40 | $9,904.00 | $16,772.00 |