- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $381.65 / $763.30 / $1,526.61
| Facility | | $381.65 | $763.30 | $1,526.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $381.65 / $610.64 / $3,272.03
| Professional | | $381.65 | $610.64 | $3,272.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $312.20 / $416.26 / $478.34
| Professional | | $312.20 | $416.26 | $478.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $330.77 / $330.77 / $330.77
| Facility | | $330.77 | $330.77 | $330.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $455.81 / $617.24 / $848.88
| Professional | | $455.81 | $617.24 | $848.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $788.75 / $829.46 / $829.46
| Professional | | $788.75 | $829.46 | $829.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $330.77 / $508.87 / $641.17
| Facility | | $330.77 | $508.87 | $641.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $525.79 / $617.24 / $732.77
| Professional | | $525.79 | $617.24 | $732.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.73 / $213.73 / $305.32
| Professional | | $213.73 | $213.73 | $305.32 |