- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $6,456.54 / $13,489.63
| Facility | | $1,659.59 | $6,456.54 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $5,370.32 / $5,370.32 / $5,370.32
| Facility | 80 | $5,370.32 | $5,370.32 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $12,302.69 / $12,882.50
| Facility | | $3,467.37 | $12,302.69 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $2,818.38 / $10,000.00
| Facility | | $933.25 | $2,818.38 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $6,918.31 / $11,748.98
| Facility | | $2,818.38 | $6,918.31 | $11,748.98 |