- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,389.44 / $3,666.78 / $7,119.04
| Facility | | $2,389.44 | $3,666.78 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $654.96 / $1,042.98 / $1,856.41
| Professional | | $654.96 | $1,042.98 | $1,856.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $983.70 / $1,617.13 / $3,942.98
| Facility | | $983.70 | $1,617.13 | $3,942.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,062.42 / $1,434.09 / $1,862.81
| Facility | | $1,062.42 | $1,434.09 | $1,862.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,775.00 / $3,482.00 / $5,454.00
| Facility | | $1,775.00 | $3,482.00 | $5,454.00 |