- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $577.96 / $655.02 / $840.67
| Facility | | $577.96 | $655.02 | $840.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.30 / $371.30 / $371.30
| Professional | | $371.30 | $371.30 | $371.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.21 / $791.63 / $875.70
| Professional | | $660.21 | $791.63 | $875.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $770.62 / $840.67 / $980.78
| Professional | | $770.62 | $840.67 | $980.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $700.56 / $840.67 / $1,050.83
| Professional | | $700.56 | $840.67 | $1,050.83 |