- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,946.53 / $4,403.47 / $7,119.04
| Facility | | $2,946.53 | $4,403.47 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $882.88 / $1,440.53 / $3,922.21
| Professional | | $882.88 | $1,440.53 | $3,922.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,240.31 / $2,093.15 / $8,847.00
| Facility | | $1,240.31 | $2,093.15 | $8,847.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,414.62 / $2,093.15 / $2,960.61
| Facility | | $1,414.62 | $2,093.15 | $2,960.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,770.00 / $6,588.00 / $10,320.00
| Facility | | $1,770.00 | $6,588.00 | $10,320.00 |