- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $503.08 / $671.97 / $671.97
| Professional | | $503.08 | $671.97 | $671.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $657.92 / $723.71 / $1,036.45
| Professional | | $657.92 | $723.71 | $1,036.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $673.59 / $776.78 / $1,171.93
| Professional | | $673.59 | $776.78 | $1,171.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $605.07 / $779.27 / $1,195.45
| Professional | | $605.07 | $779.27 | $1,195.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $503.08 / $671.97 / $671.97
| Professional | | $503.08 | $671.97 | $671.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $641.86 / $784.96 / $1,077.65
| Professional | | $641.86 | $784.96 | $1,077.65 |