- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $5,495.41 / $10,715.19
| Facility | | $1,862.09 | $5,495.41 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $630.96 / $1,412.54
| Professional | | $562.34 | $630.96 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,125.38 / $20,417.38 / $38,904.51
| Facility | | $14,125.38 | $20,417.38 | $38,904.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $891.25 / $1,380.38
| Professional | | $676.08 | $891.25 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $5,011.87 / $15,848.93
| Facility | | $1,047.13 | $5,011.87 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $812.83 / $1,318.26
| Professional | | $588.84 | $812.83 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $851.14 / $2,398.83
| Professional | | $602.56 | $851.14 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $602.56 / $1,047.13
| Professional | | $602.56 | $602.56 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $8,317.64 / $15,848.93
| Facility | | $3,548.13 | $8,317.64 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $812.83 / $1,513.56
| Professional | | $588.84 | $812.83 | $1,513.56 |