- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,386.89 / $4,771.00 / $9,539.00
| Facility | | $1,386.89 | $4,771.00 | $9,539.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,385.00 / $10,311.04 / $14,433.40
| Facility | | $6,385.00 | $10,311.04 | $14,433.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $490.00 / $610.00 / $1,399.70
| Facility | | $490.00 | $610.00 | $1,399.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,135.67 / $1,402.88 / $2,001.40
| Professional | | $1,135.67 | $1,402.88 | $2,001.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,219.71 / $1,563.53 / $2,343.84
| Facility | | $1,219.71 | $1,563.53 | $2,343.84 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $253.40 / $299.38 / $487.51
| Facility | 80 | $253.40 | $299.38 | $487.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,162.81 / $1,484.81 / $2,701.75
| Facility | | $1,162.81 | $1,484.81 | $2,701.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $327.00 / $2,397.00 / $5,202.00
| Facility | | $327.00 | $2,397.00 | $5,202.00 |