- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $296.01 / $423.48 / $586.77
| Professional | | $296.01 | $423.48 | $586.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $636.49 / $750.28 / $1,765.33
| Professional | | $636.49 | $750.28 | $1,765.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $443.64 / $648.03 / $1,131.59
| Professional | | $443.64 | $648.03 | $1,131.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $464.39 / $678.44 / $1,131.59
| Professional | | $464.39 | $678.44 | $1,131.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $525.80 / $710.74 / $2,066.17
| Professional | | $525.80 | $710.74 | $2,066.17 |