- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $712.78 / $814.99 / $1,482.04
| Professional | | $712.78 | $814.99 | $1,482.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $796.33 / $941.11 / $1,462.97
| Professional | | $796.33 | $941.11 | $1,462.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $527.28 / $665.88 / $832.94
| Professional | | $527.28 | $665.88 | $832.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,297.58 / $1,554.28 / $1,726.98
| Professional | | $1,297.58 | $1,554.28 | $1,726.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $532.55 / $773.37 / $1,064.86
| Professional | | $532.55 | $773.37 | $1,064.86 |