- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $412.34 / $524.04 / $596.86
| Professional | | $412.34 | $524.04 | $596.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.25 / $662.91 / $1,030.19
| Professional | | $512.25 | $662.91 | $1,030.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.28 / $783.27 / $1,110.67
| Professional | | $562.28 | $783.27 | $1,110.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $647.98 / $749.71 / $1,150.09
| Professional | | $647.98 | $749.71 | $1,150.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $412.34 / $596.86 / $753.42
| Professional | | $412.34 | $596.86 | $753.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $488.81 / $704.79 / $911.36
| Professional | | $488.81 | $704.79 | $911.36 |