- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $346.74 / $416.87
| Facility | | $346.74 | $346.74 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $467.74 / $851.14
| Professional | | $295.12 | $467.74 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 54
- Low / Median / High Price
- $151.36 / $501.19 / $524.81
| Professional | 54 | $151.36 | $501.19 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $501.19 / $741.31
| Professional | | $331.13 | $501.19 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $501.19 / $758.58 / $1,096.48
| Professional | 50 | $501.19 | $758.58 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $467.74 / $776.25
| Professional | | $331.13 | $467.74 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $537.03 / $1,023.29
| Professional | | $426.58 | $537.03 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $346.74 / $346.74
| Facility | | $346.74 | $346.74 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $446.68 / $758.58
| Professional | | $295.12 | $446.68 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 54
- Low / Median / High Price
- $288.40 / $380.19 / $512.86
| Professional | 54 | $288.40 | $380.19 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $426.58 / $758.58
| Professional | | $269.15 | $426.58 | $758.58 |