- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $700.56 / $805.64 / $1,401.12
| Facility | | $700.56 | $805.64 | $1,401.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $595.48 / $595.48 / $595.48
| Professional | | $595.48 | $595.48 | $595.48 |
- 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
- $454.56 / $659.07 / $777.70
| Professional | | $454.56 | $659.07 | $777.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $294.24 / $294.24 / $420.34
| Professional | | $294.24 | $294.24 | $420.34 |