- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $800.15 / $955.31 / $1,704.52
| Facility | | $800.15 | $955.31 | $1,704.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $796.09 / $804.05 / $968.18
| Professional | | $796.09 | $804.05 | $968.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $867.74 / $1,263.79 / $2,387.27
| Facility | | $867.74 | $1,263.79 | $2,387.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $796.09 / $796.09 / $800.15
| Professional | | $796.09 | $796.09 | $800.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $751.03 / $796.09 / $806.51
| Facility | | $751.03 | $796.09 | $806.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $796.09 / $796.09 / $806.51
| Professional | | $796.09 | $796.09 | $806.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.44 / $796.09 / $992.91
| Professional | | $318.44 | $796.09 | $992.91 |