- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.09 / $407.43 / $929.80
| Facility | | $162.09 | $407.43 | $929.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.66 / $162.09 / $172.56
| Professional | | $130.66 | $162.09 | $172.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $106.66 / $597.90 / $1,008.39
| Facility | | $106.66 | $597.90 | $1,008.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.62 / $244.45 / $526.84
| Professional | | $176.62 | $244.45 | $526.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $246.74 / $527.46 / $1,486.35
| Facility | | $246.74 | $527.46 | $1,486.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $468.54 / $742.34 / $1,006.35
| Professional | | $468.54 | $742.34 | $1,006.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.26 / $160.34 / $535.85
| Professional | | $123.26 | $160.34 | $535.85 |