- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $836.47 / $1,032.19 / $1,992.81
| Facility | | $836.47 | $1,032.19 | $1,992.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.23 / $836.47 / $1,032.19
| Professional | | $691.23 | $836.47 | $1,032.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $534.44 / $702.94 / $1,359.70
| Facility | | $534.44 | $702.94 | $1,359.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $360.74 / $646.13 / $820.58
| Professional | | $360.74 | $646.13 | $820.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $877.36 / $1,548.29 / $1,961.16
| Facility | | $877.36 | $1,548.29 | $1,961.16 |