- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $256.92 / $356.35 / $420.25
| Professional | | $256.92 | $356.35 | $420.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,309.34 / $1,309.34 / $1,309.34
| Professional | | $1,309.34 | $1,309.34 | $1,309.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $343.10 / $530.87 / $782.54
| Professional | | $343.10 | $530.87 | $782.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $410.45 / $516.19 / $782.54
| Professional | | $410.45 | $516.19 | $782.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $393.25 / $491.50 / $1,428.82
| Professional | | $393.25 | $491.50 | $1,428.82 |