- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $322.33 / $439.60 / $845.73
| Professional | | $322.33 | $439.60 | $845.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $450.78 / $553.64 / $1,641.97
| Professional | | $450.78 | $553.64 | $1,641.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $334.85 / $481.71 / $1,284.21
| Professional | | $334.85 | $481.71 | $1,284.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $438.71 / $649.98 / $1,284.21
| Professional | | $438.71 | $649.98 | $1,284.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $462.90 / $571.86 / $1,841.26
| Professional | | $462.90 | $571.86 | $1,841.26 |