- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,124.92 / $5,048.00 / $9,539.00
| Facility | | $2,124.92 | $5,048.00 | $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
- $1,706.94 / $2,048.33 / $2,526.27
| Professional | | $1,706.94 | $2,048.33 | $2,526.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,120.12 / $2,588.50 / $3,740.94
| Facility | | $2,120.12 | $2,588.50 | $3,740.94 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $595.67 / $651.75 / $748.19
| Facility | 80 | $595.67 | $651.75 | $748.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,728.37 / $2,385.66 / $4,501.79
| Facility | | $1,728.37 | $2,385.66 | $4,501.79 |
- 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 |