- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $348.37 / $490.32 / $593.87
| Professional | | $348.37 | $490.32 | $593.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $604.79 / $615.02 / $978.69
| Professional | | $604.79 | $615.02 | $978.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.36 / $471.68 / $878.69
| Professional | | $335.36 | $471.68 | $878.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.36 / $550.00 / $878.69
| Professional | | $335.36 | $550.00 | $878.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $542.04 / $630.47 / $1,252.83
| Professional | | $542.04 | $630.47 | $1,252.83 |