- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $5,495.41 / $10,471.29
| Facility | | $1,202.26 | $5,495.41 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $616.60 / $1,513.56
| Professional | | $407.38 | $616.60 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $12,302.69 / $16,595.87
| Facility | | $7,413.10 | $12,302.69 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $870.96 / $1,258.93
| Professional | | $501.19 | $870.96 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $851.14 / $4,365.16
| Facility | | $851.14 | $851.14 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $851.14 / $1,445.44
| Professional | | $575.44 | $851.14 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $851.14 / $1,230.27
| Professional | | $630.96 | $851.14 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $7,079.46 / $11,220.18
| Facility | | $4,570.88 | $7,079.46 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $758.58 / $1,513.56
| Professional | | $416.87 | $758.58 | $1,513.56 |