- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $395.50 / $550.88 / $1,377.19
| Professional | | $395.50 | $550.88 | $1,377.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.59 / $60.59 / $427.28
| Professional | | $60.59 | $60.59 | $427.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $860.24 / $860.24 / $1,030.66
| Professional | | $860.24 | $860.24 | $1,030.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $706.25 / $706.25 / $706.25
| Professional | | $706.25 | $706.25 | $706.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $296.63 / $296.63 / $706.25
| Professional | | $296.63 | $296.63 | $706.25 |