- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,049.86 / $4,590.00 / $6,915.00
| Facility | | $1,049.86 | $4,590.00 | $6,915.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $746.52 / $2,354.21 / $5,084.83
| Facility | | $746.52 | $2,354.21 | $5,084.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,414.37 / $1,724.07 / $74,999.25
| Facility | | $1,414.37 | $1,724.07 | $74,999.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $551.00 / $1,325.29 / $1,668.88
| Facility | | $551.00 | $1,325.29 | $1,668.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $900.33 / $1,167.78 / $6,611.91
| Professional | | $900.33 | $1,167.78 | $6,611.91 |
- Facility/Professional
- Professional
- Modifier
- 80
- Low / Median / High Price
- $93.06 / $93.06 / $93.06
| Professional | 80 | $93.06 | $93.06 | $93.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,214.00 / $4,500.00 / $6,995.00
| Facility | | $1,214.00 | $4,500.00 | $6,995.00 |