- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $324.58 / $373.27 / $649.16
| Facility | | $324.58 | $373.27 | $649.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.17 / $373.27 / $373.27
| Professional | | $253.17 | $373.27 | $373.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.15 / $191.92 / $258.19
| Facility | | $158.15 | $191.92 | $258.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.35 / $248.87 / $293.67
| Professional | | $169.35 | $248.87 | $293.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $206.76 / $263.73 / $1,017.66
| Facility | | $206.76 | $263.73 | $1,017.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.72 / $144.50 / $342.25
| Professional | | $134.72 | $144.50 | $342.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.32 / $136.32 / $324.58
| Professional | | $136.32 | $136.32 | $324.58 |