- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $4,897.79 / $11,748.98
| Facility | | $1,096.48 | $4,897.79 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $602.56 / $1,202.26
| Professional | | $489.78 | $602.56 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $6,309.57 / $13,803.84
| Facility | | $2,884.03 | $6,309.57 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $707.95 / $1,380.38
| Professional | | $446.68 | $707.95 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $1,698.24 / $12,302.69
| Facility | | $851.14 | $1,698.24 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $831.76 / $1,698.24
| Professional | | $512.86 | $831.76 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $5,623.41 / $12,302.69
| Facility | | $1,905.46 | $5,623.41 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $724.44 / $1,288.25
| Professional | | $489.78 | $724.44 | $1,288.25 |