- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $616.60 / $776.25
| Professional | | $549.54 | $616.60 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $645.65 / $724.44
| Professional | | $151.36 | $645.65 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $489.78 / $26,302.68
| Facility | | $489.78 | $489.78 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $3,630.78 / $3,630.78
| Professional | | $457.09 | $3,630.78 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $489.78 / $489.78
| Professional | | $489.78 | $489.78 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $562.34 / $562.34
| Professional | | $562.34 | $562.34 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.08 / $562.34 / $676.08
| Professional | | $7.08 | $562.34 | $676.08 |