- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,356.77 / $6,641.48 / $16,467.00
| Facility | | $1,356.77 | $6,641.48 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,073.24 / $5,808.35 / $9,670.36
| Facility | | $3,073.24 | $5,808.35 | $9,670.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $715.00 / $715.00 / $1,985.43
| Facility | | $715.00 | $715.00 | $1,985.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $925.00 / $1,356.77 / $2,145.61
| Facility | | $925.00 | $1,356.77 | $2,145.61 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $185.00 / $274.74 / $429.12
| Facility | 80 | $185.00 | $274.74 | $429.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.00 / $10,257.00 / $16,249.00
| Facility | | $1,258.00 | $10,257.00 | $16,249.00 |