- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $7,943.28 / $16,595.87
| Facility | | $380.19 | $7,943.28 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $14,791.08 / $15,488.17
| Facility | | $562.34 | $14,791.08 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $562.34 / $758.58
| Professional | | $562.34 | $562.34 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $436.52 / $741.31
| Facility | | $316.23 | $436.52 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $6,760.83 / $9,120.11
| Facility | | $1,479.11 | $6,760.83 | $9,120.11 |