- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $729.59 / $876.67 / $1,429.63
| Professional | | $729.59 | $876.67 | $1,429.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,344.12 / $1,584.41 / $3,218.26
| Professional | | $1,344.12 | $1,584.41 | $3,218.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $770.04 / $1,316.92 / $1,550.56
| Professional | | $770.04 | $1,316.92 | $1,550.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $770.04 / $1,256.71 / $1,550.56
| Professional | | $770.04 | $1,256.71 | $1,550.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $999.65 / $1,205.26 / $3,657.46
| Professional | | $999.65 | $1,205.26 | $3,657.46 |