- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $416.87 / $2,290.87
| Facility | | $346.74 | $416.87 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $851.14 / $851.14 / $851.14
| Facility | 54 | $851.14 | $851.14 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $602.56 / $870.96
| Facility | | $457.09 | $602.56 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $758.58 / $831.76
| Professional | | $758.58 | $758.58 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $630.96 / $776.25
| Professional | | $398.11 | $630.96 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $812.83 / $812.83
| Facility | | $812.83 | $812.83 | $812.83 |