- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $394.13 / $394.13 / $418.45
| Professional | | $394.13 | $394.13 | $418.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $454.94 / $536.28 / $1,311.30
| Professional | | $454.94 | $536.28 | $1,311.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.15 / $557.05 / $775.59
| Professional | | $380.15 | $557.05 | $775.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $353.20 / $508.21 / $775.59
| Professional | | $353.20 | $508.21 | $775.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $383.73 / $487.14 / $833.97
| Professional | | $383.73 | $487.14 | $833.97 |