- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $3,981.07 / $10,715.19
| Facility | | $1,096.48 | $3,981.07 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $3,715.35 / $3,715.35 / $3,715.35
| Facility | 80 | $3,715.35 | $3,715.35 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $5,623.41 / $7,585.78
| Facility | | $4,786.30 | $5,623.41 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $7,762.47 / $7,762.47
| Facility | | $3,801.89 | $7,762.47 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $5,370.32 / $8,709.64
| Facility | | $2,454.71 | $5,370.32 | $8,709.64 |