- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,633.00 / $6,091.63 / $15,165.00
| Facility | | $3,633.00 | $6,091.63 | $15,165.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,524.00 / $22,312.00 / $37,718.00
| Facility | | $12,524.00 | $22,312.00 | $37,718.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,980.29 / $6,152.12 / $8,777.34
| Professional | | $4,980.29 | $6,152.12 | $8,777.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.96 / $6,762.79 / $10,294.85
| Facility | | $5,341.96 | $6,762.79 | $10,294.85 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $1,204.72 / $1,231.00 / $2,137.84
| Facility | 80 | $1,204.72 | $1,231.00 | $2,137.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,024.21 / $6,188.60 / $10,360.67
| Facility | | $5,024.21 | $6,188.60 | $10,360.67 |
- 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 |