- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $2,691.53 / $8,317.64
| Facility | | $338.84 | $2,691.53 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $707.95 / $1,548.82 / $3,630.78
| Facility | 50 | $707.95 | $1,548.82 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $316.23 / $776.25
| Professional | | $208.93 | $316.23 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $346.74 / $630.96 / $1,862.09
| Professional | 50 | $346.74 | $630.96 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- 54
- Low / Median / High Price
- $165.96 / $269.15 / $501.19
| Professional | 54 | $165.96 | $269.15 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,890.45 / $9,549.93
| Facility | | $1,698.24 | $3,890.45 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $331.13 / $660.69
| Professional | | $213.80 | $331.13 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $316.23 / $478.63 / $912.01
| Professional | 50 | $316.23 | $478.63 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.90 / $398.11 / $1,819.70
| Facility | | $134.90 | $398.11 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $239.88 / $239.88 / $239.88
| Facility | 54 | $239.88 | $239.88 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $354.81 / $724.44
| Professional | | $208.93 | $354.81 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $1,862.09 / $4,677.35
| Facility | | $467.74 | $1,862.09 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $295.12 / $524.81
| Professional | | $194.98 | $295.12 | $524.81 |