- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.43 / $1,536.80 / $4,594.70
| Facility | | $269.43 | $1,536.80 | $4,594.70 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $816.94 / $816.94 / $816.94
| Facility | 50 | $816.94 | $816.94 | $816.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.84 / $269.43 / $664.86
| Professional | | $104.84 | $269.43 | $664.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.19 / $279.63 / $796.64
| Professional | | $128.19 | $279.63 | $796.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $768.25 / $977.53 / $1,129.03
| Facility | | $768.25 | $977.53 | $1,129.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $308.64 / $714.76 / $978.27
| Professional | | $308.64 | $714.76 | $978.27 |