- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,072.78 / $5,412.00 / $14,867.45
| Facility | | $1,072.78 | $5,412.00 | $14,867.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,076.18 / $14,552.64 / $20,189.45
| Facility | | $10,076.18 | $14,552.64 | $20,189.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $911.08 / $1,093.30 / $1,348.40
| Professional | | $911.08 | $1,093.30 | $1,348.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $902.96 / $1,267.94 / $1,782.62
| Facility | | $902.96 | $1,267.94 | $1,782.62 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $243.59 / $342.84 / $384.13
| Facility | 80 | $243.59 | $342.84 | $384.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.19 / $1,257.29 / $2,326.38
| Facility | | $954.19 | $1,257.29 | $2,326.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $9,373.00 / $17,192.00
| Facility | | $6,303.00 | $9,373.00 | $17,192.00 |