- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $313.32 / $467.87 / $703.87
| Professional | | $313.32 | $467.87 | $703.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $412.73 / $485.57 / $701.34
| Professional | | $412.73 | $485.57 | $701.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $449.35 / $715.20 / $1,061.71
| Professional | | $449.35 | $715.20 | $1,061.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $462.08 / $680.13 / $1,207.16
| Professional | | $462.08 | $680.13 | $1,207.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $330.25 / $501.12 / $703.87
| Professional | | $330.25 | $501.12 | $703.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $518.22 / $769.33 / $1,058.28
| Professional | | $518.22 | $769.33 | $1,058.28 |