- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,633.00 / $5,282.00 / $10,767.00
| Facility | | $3,633.00 | $5,282.00 | $10,767.00 |
- 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 / $3,683.98
| Facility | | $490.00 | $610.00 | $3,683.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,955.47 / $3,650.87 / $5,286.60
| Professional | | $2,955.47 | $3,650.87 | $5,286.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,813.89 / $3,968.42 / $6,012.78
| Facility | | $2,813.89 | $3,968.42 | $6,012.78 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $450.40 / $789.10 / $1,292.77
| Facility | 80 | $450.40 | $789.10 | $1,292.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,157.50 / $3,815.57 / $6,959.72
| Facility | | $2,157.50 | $3,815.57 | $6,959.72 |
- 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 |