- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.71 / $1,174.90 / $4,570.88
| Facility | | $104.71 | $1,174.90 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $812.83 / $812.83 / $812.83
| Facility | 50 | $812.83 | $812.83 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $269.15 / $776.25
| Professional | | $104.71 | $269.15 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $281.84 / $758.58
| Professional | | $128.82 | $281.84 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $977.24 / $1,122.02
| Facility | | $794.33 | $977.24 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $5,011.87 / $5,011.87
| Facility | | $5,011.87 | $5,011.87 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $257.04 / $870.96
| Professional | | $109.65 | $257.04 | $870.96 |