- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $719.19 / $719.19 / $863.03
| Facility | | $719.19 | $719.19 | $863.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $687.10 / $719.19 / $1,052.08
| Professional | | $687.10 | $719.19 | $1,052.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $456.71 / $478.36 / $478.36
| Professional | | $456.71 | $478.36 | $478.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $781.69 / $781.69 / $781.69
| Professional | | $781.69 | $781.69 | $781.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $492.31 / $492.31 / $590.97
| Professional | | $492.31 | $492.31 | $590.97 |