- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $258.56 / $339.47 / $512.52
| Professional | | $258.56 | $339.47 | $512.52 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $416.31 / $416.31 / $587.26
| Professional | 50 | $416.31 | $416.31 | $587.26 |
- Facility/Professional
- Professional
- Modifier
- 54
- Low / Median / High Price
- $223.02 / $255.73 / $982.08
| Professional | 54 | $223.02 | $255.73 | $982.08 |
- Facility/Professional
- Professional
- Modifier
- 55
- Low / Median / High Price
- $44.60 / $50.92 / $163.86
| Professional | 55 | $44.60 | $50.92 | $163.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $775.20 / $775.20 / $837.48
| Facility | | $775.20 | $775.20 | $837.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $558.20 / $601.63 / $887.43
| Professional | | $558.20 | $601.63 | $887.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $261.08 / $377.16 / $549.29
| Professional | | $261.08 | $377.16 | $549.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.19 / $377.16 / $549.29
| Professional | | $255.19 | $377.16 | $549.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.18 / $404.39 / $1,016.99
| Professional | | $335.18 | $404.39 | $1,016.99 |