- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $8,709.64 / $13,182.57
| Facility | | $1,737.80 | $8,709.64 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $4,897.79 / $7,585.78
| Facility | | $3,311.31 | $4,897.79 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,445.44 / $2,290.87
| Facility | | $1,230.27 | $1,445.44 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $616.60 / $4,365.16
| Facility | | $446.68 | $616.60 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $741.31 / $7,762.47
| Facility | | $457.09 | $741.31 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $1,122.02 / $1,737.80
| Professional | | $616.60 | $1,122.02 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $7,943.28 / $7,943.28
| Facility | | $5,370.32 | $7,943.28 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $7,413.10 / $9,120.11
| Facility | | $4,897.79 | $7,413.10 | $9,120.11 |