- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $3,548.13 / $8,511.38
| Facility | | $281.84 | $3,548.13 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $524.81 / $1,380.38
| Professional | | $251.19 | $524.81 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $616.60 / $616.60 / $616.60
| Professional | 50 | $616.60 | $616.60 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- 54
- Low / Median / High Price
- $331.13 / $446.68 / $645.65
| Professional | 54 | $331.13 | $446.68 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $575.44 / $812.83
| Professional | | $295.12 | $575.44 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $4,365.16 / $8,511.38
| Facility | | $3,388.44 | $4,365.16 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $512.86 / $707.95
| Professional | | $295.12 | $512.86 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $204.17 / $204.17
| Facility | | $204.17 | $204.17 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $741.31 / $1,023.29
| Professional | | $346.74 | $741.31 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $537.03 / $1,230.27
| Facility | | $316.23 | $537.03 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $1,096.48 / $1,096.48 / $1,096.48
| Facility | 54 | $1,096.48 | $1,096.48 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $602.56 / $2,630.27
| Professional | | $371.54 | $602.56 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $741.31 / $1,023.29
| Professional | | $707.95 | $741.31 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $204.17 / $204.17
| Facility | | $204.17 | $204.17 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $812.83 / $1,071.52
| Professional | | $758.58 | $812.83 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $1,230.27 / $4,466.84
| Facility | | $309.03 | $1,230.27 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $524.81 / $812.83
| Professional | | $346.74 | $524.81 | $812.83 |