- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.69 / $595.82 / $595.82
| Facility | | $416.69 | $595.82 | $595.82 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $312.52 / $312.52 / $312.52
| Facility | 54 | $312.52 | $312.52 | $312.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $504.97 / $642.25 / $1,039.99
| Facility | | $504.97 | $642.25 | $1,039.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $646.00 / $1,020.65 / $1,969.98
| Facility | | $646.00 | $1,020.65 | $1,969.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $433.27 / $677.80 / $820.92
| Professional | | $433.27 | $677.80 | $820.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,000.00 / $2,000.00 / $2,000.00
| Facility | | $2,000.00 | $2,000.00 | $2,000.00 |