- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,557.44 / $5,373.20 / $17,247.00
| Facility | | $1,557.44 | $5,373.20 | $17,247.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,277.31 / $9,228.26 / $15,345.00
| Facility | | $4,277.31 | $9,228.26 | $15,345.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $988.00 / $1,449.41 / $2,400.00
| Facility | | $988.00 | $1,449.41 | $2,400.00 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $197.60 / $284.94 / $504.20
| Facility | 80 | $197.60 | $284.94 | $504.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $15,451.00 / $23,485.00
| Facility | | $2,912.00 | $15,451.00 | $23,485.00 |