- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,175.78 / $5,048.00 / $9,539.00
| Facility | | $2,175.78 | $5,048.00 | $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 / $2,193.30
| Facility | | $490.00 | $610.00 | $2,193.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,769.84 / $2,186.28 / $3,137.88
| Professional | | $1,769.84 | $2,186.28 | $3,137.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,817.34 / $2,373.58 / $3,554.43
| Facility | | $1,817.34 | $2,373.58 | $3,554.43 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $324.00 / $469.64 / $764.83
| Facility | 80 | $324.00 | $469.64 | $764.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,630.68 / $2,303.10 / $4,204.17
| Facility | | $1,630.68 | $2,303.10 | $4,204.17 |
- 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 |