- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $640.50 / $893.81 / $938.84
| Professional | | $640.50 | $893.81 | $938.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $963.70 / $963.70 / $2,851.74
| Professional | | $963.70 | $963.70 | $2,851.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $863.56 / $1,278.81 / $1,711.96
| Professional | | $863.56 | $1,278.81 | $1,711.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $791.27 / $1,135.56 / $1,711.96
| Professional | | $791.27 | $1,135.56 | $1,711.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $932.62 / $1,057.74 / $1,797.08
| Professional | | $932.62 | $1,057.74 | $1,797.08 |