- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.36 / $5,873.00 / $10,918.47
| Facility | | $1,513.36 | $5,873.00 | $10,918.47 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $4,053.04 / $4,053.04 / $4,053.04
| Facility | 80 | $4,053.04 | $4,053.04 | $4,053.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,700.16 / $19,158.88 / $21,611.98
| Facility | | $16,700.16 | $19,158.88 | $21,611.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,917.17 / $17,367.83 / $33,122.22
| Facility | | $15,917.17 | $17,367.83 | $33,122.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,682.00 / $10,536.00 / $23,291.00
| Facility | | $5,682.00 | $10,536.00 | $23,291.00 |