- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $491.91 / $683.25 / $685.36
| Professional | | $491.91 | $683.25 | $685.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $824.10 / $971.43 / $2,087.79
| Professional | | $824.10 | $971.43 | $2,087.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $626.53 / $965.45 / $1,293.58
| Professional | | $626.53 | $965.45 | $1,293.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $596.37 / $855.42 / $1,293.58
| Professional | | $596.37 | $855.42 | $1,293.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $674.95 / $812.48 / $2,361.92
| Professional | | $674.95 | $812.48 | $2,361.92 |