- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $374.10 / $461.25 / $550.84
| Professional | | $374.10 | $461.25 | $550.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $835.71 / $1,038.23 / $1,221.45
| Professional | | $835.71 | $1,038.23 | $1,221.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $783.71 / $1,078.92 / $1,643.50
| Professional | | $783.71 | $1,078.92 | $1,643.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $565.52 / $1,010.52 / $3,975.04
| Professional | | $565.52 | $1,010.52 | $3,975.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $557.58 / $842.98 / $1,188.88
| Professional | | $557.58 | $842.98 | $1,188.88 |