- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $565.26 / $565.26 / $585.30
| Professional | | $565.26 | $565.26 | $585.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $689.18 / $812.39 / $1,794.63
| Professional | | $689.18 | $812.39 | $1,794.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $539.17 / $790.88 / $1,092.47
| Professional | | $539.17 | $790.88 | $1,092.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $503.40 / $723.84 / $1,092.47
| Professional | | $503.40 | $723.84 | $1,092.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $564.75 / $686.17 / $1,994.74
| Professional | | $564.75 | $686.17 | $1,994.74 |