- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,019.93 / $4,905.47 / $9,539.00
| Facility | | $2,019.93 | $4,905.47 | $9,539.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,153.00 / $7,363.00 / $9,410.00
| Facility | | $6,153.00 | $7,363.00 | $9,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,616.88 / $1,940.26 / $2,392.98
| Professional | | $1,616.88 | $1,940.26 | $2,392.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,007.61 / $2,475.62 / $3,660.20
| Facility | | $2,007.61 | $2,475.62 | $3,660.20 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $568.24 / $618.83 / $711.25
| Facility | 80 | $568.24 | $618.83 | $711.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,706.07 / $2,416.01 / $4,462.00
| Facility | | $1,706.07 | $2,416.01 | $4,462.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,547.00 / $3,130.00 / $5,226.00
| Facility | | $1,547.00 | $3,130.00 | $5,226.00 |