- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $10,232.93 / $21,379.62
| Facility | | $4,466.84 | $10,232.93 | $21,379.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $11,748.98 / $22,387.21
| Facility | | $6,918.31 | $11,748.98 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $60.26 / $100.00 / $6,025.60
| Facility | | $60.26 | $100.00 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,148.15 / $1,479.11
| Professional | | $1,023.29 | $1,148.15 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,288.25 / $2,454.71
| Professional | | $977.24 | $1,288.25 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- 80
- Low / Median / High Price
- $501.19 / $501.19 / $501.19
| Professional | 80 | $501.19 | $501.19 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $56.23 / $14,791.08
| Facility | | $54.95 | $56.23 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,479.11 / $2,137.96
| Facility | | $1,122.02 | $1,479.11 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $6,165.95 / $18,620.87
| Facility | | $2,041.74 | $6,165.95 | $18,620.87 |