- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,802.32 / $5,048.00 / $9,539.00
| Facility | | $2,802.32 | $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 / $2,818.19
| Facility | | $490.00 | $610.00 | $2,818.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,271.06 / $2,805.42 / $4,031.22
| Professional | | $2,271.06 | $2,805.42 | $4,031.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,255.56 / $3,038.31 / $4,577.97
| Facility | | $2,255.56 | $3,038.31 | $4,577.97 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $381.40 / $601.73 / $984.48
| Facility | 80 | $381.40 | $601.73 | $984.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,848.81 / $2,913.44 / $5,298.95
| Facility | | $1,848.81 | $2,913.44 | $5,298.95 |
- 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 |