- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,445.44 / $2,398.83
| Facility | | $758.58 | $1,445.44 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $338.84 / $588.84
| Professional | | $208.93 | $338.84 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $346.74 / $1,862.09 / $1,862.09
| Professional | 50 | $346.74 | $1,862.09 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $213.80 / $245.47
| Professional | | $162.18 | $213.80 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $234.42 / $234.42 / $346.74
| Professional | 50 | $234.42 | $234.42 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,513.56 / $2,041.74
| Facility | | $1,258.93 | $1,513.56 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $501.19 / $588.84
| Professional | | $331.13 | $501.19 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $338.84 / $338.84
| Facility | | $338.84 | $338.84 | $338.84 |
- 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
- $169.82 / $309.03 / $870.96
| Professional | | $169.82 | $309.03 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $1,148.15 / $2,511.89
| Facility | | $398.11 | $1,148.15 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $234.42 / $316.23
| Professional | | $177.83 | $234.42 | $316.23 |