- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $305.60 / $319.35 / $319.35
| Professional | | $305.60 | $319.35 | $319.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $391.07 / $460.98 / $936.34
| Professional | | $391.07 | $460.98 | $936.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.52 / $448.35 / $583.22
| Professional | | $275.52 | $448.35 | $583.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $267.75 / $384.15 / $583.22
| Professional | | $267.75 | $384.15 | $583.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $322.87 / $366.31 / $1,064.89
| Professional | | $322.87 | $366.31 | $1,064.89 |