- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.93 / $330.36 / $536.15
| Professional | | $198.93 | $330.36 | $536.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $388.84 / $681.61 / $1,196.56
| Professional | | $388.84 | $681.61 | $1,196.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $425.34 / $764.08 / $1,372.17
| Professional | | $425.34 | $764.08 | $1,372.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $421.22 / $723.75 / $1,307.98
| Professional | | $421.22 | $723.75 | $1,307.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $379.50 / $699.94 / $1,477.84
| Professional | | $379.50 | $699.94 | $1,477.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $379.50 / $621.00 / $1,312.28
| Professional | | $379.50 | $621.00 | $1,312.28 |