- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.64 / $852.89 / $1,483.28
| Facility | | $741.64 | $852.89 | $1,483.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $578.48 / $630.39 / $630.39
| Professional | | $578.48 | $630.39 | $630.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.89 / $652.76 / $878.17
| Facility | | $537.89 | $652.76 | $878.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $481.21 / $659.07 / $777.70
| Professional | | $481.21 | $659.07 | $777.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.49 / $311.49 / $444.98
| Professional | | $311.49 | $311.49 | $444.98 |