- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $575.44 / $977.24
| Professional | | $302.00 | $575.44 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $645.65 / $977.24
| Professional | | $407.38 | $645.65 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $645.65 / $977.24
| Professional | | $562.34 | $645.65 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $630.96 / $812.83
| Professional | | $524.81 | $630.96 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $676.08 / $1,479.11
| Professional | | $512.86 | $676.08 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $707.95 / $933.25
| Professional | | $512.86 | $707.95 | $933.25 |