- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,000.00 / $6,690.70 / $13,151.00
| Facility | | $2,000.00 | $6,690.70 | $13,151.00 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $5,427.95 / $5,427.95 / $5,427.95
| Facility | 80 | $5,427.95 | $5,427.95 | $5,427.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,285.10 / $8,838.39 / $10,621.55
| Facility | | $3,285.10 | $8,838.39 | $10,621.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $786.52 / $1,608.69 / $9,507.00
| Facility | | $786.52 | $1,608.69 | $9,507.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,269.00 / $6,170.00 / $13,689.00
| Facility | | $2,269.00 | $6,170.00 | $13,689.00 |