- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $1,258.93 / $1,318.26
| Facility | | $831.76 | $1,258.93 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $331.13 / $741.31
| Professional | | $245.47 | $331.13 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $436.52 / $489.78 / $933.25
| Professional | 50 | $436.52 | $489.78 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 54
- Low / Median / High Price
- $489.78 / $489.78 / $489.78
| Professional | 54 | $489.78 | $489.78 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $562.34 / $562.34
| Facility | | $562.34 | $562.34 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $281.84 / $501.19
| Professional | | $251.19 | $281.84 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,318.26 / $6,918.31
| Facility | | $1,318.26 | $1,318.26 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $323.59 / $2,570.40
| Professional | | $323.59 | $323.59 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $467.74 / $467.74 / $489.78
| Professional | 50 | $467.74 | $467.74 | $489.78 |
- 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
- $234.42 / $281.84 / $380.19
| Professional | | $234.42 | $281.84 | $380.19 |