- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $884.81 / $1,024.31 / $1,796.86
| Facility | | $884.81 | $1,024.31 | $1,796.86 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $288.00 / $288.00 / $288.00
| Facility | 80 | $288.00 | $288.00 | $288.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,570.64 / $8,169.55 / $12,556.00
| Facility | | $3,570.64 | $8,169.55 | $12,556.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,040.04 / $1,040.04 / $1,431.75
| Facility | | $1,040.04 | $1,040.04 | $1,431.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,403.00 / $3,325.00 / $8,198.00
| Facility | | $1,403.00 | $3,325.00 | $8,198.00 |