- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,194.72 / $3,666.78 / $7,119.04
| Facility | | $1,194.72 | $3,666.78 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $784.76 / $1,216.50 / $2,801.83
| Professional | | $784.76 | $1,216.50 | $2,801.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,313.07 / $2,084.36 / $7,896.02
| Facility | | $1,313.07 | $2,084.36 | $7,896.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,532.99 / $2,047.76 / $2,961.89
| Facility | | $1,532.99 | $2,047.76 | $2,961.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $6,588.00 / $10,320.00
| Facility | | $5,341.00 | $6,588.00 | $10,320.00 |