- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $325.69 / $380.76 / $855.17
| Professional | | $325.69 | $380.76 | $855.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $449.36 / $545.58 / $1,671.86
| Professional | | $449.36 | $545.58 | $1,671.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $343.11 / $490.95 / $1,097.79
| Professional | | $343.11 | $490.95 | $1,097.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $413.08 / $559.21 / $1,097.79
| Professional | | $413.08 | $559.21 | $1,097.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $413.08 / $500.44 / $1,601.14
| Professional | | $413.08 | $500.44 | $1,601.14 |