- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $408.70 / $571.22 / $785.24
| Professional | | $408.70 | $571.22 | $785.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $860.20 / $860.20 / $2,391.94
| Professional | | $860.20 | $860.20 | $2,391.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $617.74 / $876.54 / $1,507.48
| Professional | | $617.74 | $876.54 | $1,507.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $642.09 / $906.99 / $1,507.48
| Professional | | $642.09 | $906.99 | $1,507.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $734.80 / $931.40 / $2,752.47
| Professional | | $734.80 | $931.40 | $2,752.47 |