- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $498.47 / $498.47 / $868.33
| Professional | | $498.47 | $498.47 | $868.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $576.03 / $660.78 / $1,054.03
| Professional | | $576.03 | $660.78 | $1,054.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $615.65 / $749.64 / $1,073.98
| Professional | | $615.65 | $749.64 | $1,073.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $558.78 / $719.67 / $1,104.01
| Professional | | $558.78 | $719.67 | $1,104.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $498.47 / $498.47 / $868.33
| Professional | | $498.47 | $498.47 | $868.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $610.12 / $719.67 / $998.62
| Professional | | $610.12 | $719.67 | $998.62 |