- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $465.20 / $531.20 / $586.33
| Professional | | $465.20 | $531.20 | $586.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $673.63 / $794.06 / $1,813.11
| Professional | | $673.63 | $794.06 | $1,813.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $488.47 / $753.47 / $1,091.35
| Professional | | $488.47 | $753.47 | $1,091.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $542.17 / $702.36 / $1,091.35
| Professional | | $542.17 | $702.36 | $1,091.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $556.04 / $685.47 / $1,992.70
| Professional | | $556.04 | $685.47 | $1,992.70 |