- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,563.18 / $9,622.00 / $18,276.00
| Facility | | $1,563.18 | $9,622.00 | $18,276.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,277.31 / $9,279.28 / $15,370.07
| Facility | | $4,277.31 | $9,279.28 | $15,370.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,063.00 / $1,517.83 / $2,387.94
| Facility | | $1,063.00 | $1,517.83 | $2,387.94 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $212.60 / $286.57 / $440.53
| Facility | 80 | $212.60 | $286.57 | $440.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,298.00 / $15,713.00 / $25,628.00
| Facility | | $6,298.00 | $15,713.00 | $25,628.00 |