- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $280.14 / $426.41 / $642.41
| Professional | | $280.14 | $426.41 | $642.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $556.38 / $657.59 / $1,948.14
| Professional | | $556.38 | $657.59 | $1,948.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $409.90 / $662.02 / $1,174.04
| Professional | | $409.90 | $662.02 | $1,174.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $452.16 / $674.76 / $1,174.04
| Professional | | $452.16 | $674.76 | $1,174.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $521.53 / $627.03 / $2,143.66
| Professional | | $521.53 | $627.03 | $2,143.66 |