- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,325.36 / $11,609.00 / $18,593.33
| Facility | | $1,325.36 | $11,609.00 | $18,593.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $946.69 / $1,358.00 / $2,381.73
| Facility | | $946.69 | $1,358.00 | $2,381.73 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $234.00 / $271.60 / $476.35
| Facility | 80 | $234.00 | $271.60 | $476.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,366.00 / $9,541.00 / $14,589.00
| Facility | | $3,366.00 | $9,541.00 | $14,589.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $6,235.88 / $7,653.10
| Facility | | $55.00 | $6,235.88 | $7,653.10 |