- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.55 / $382.19 / $382.19
| Facility | | $294.55 | $382.19 | $382.19 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $220.91 / $220.91 / $244.73
| Facility | 54 | $220.91 | $220.91 | $244.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.98 / $294.55 / $407.84
| Professional | | $254.98 | $294.55 | $407.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $618.73 / $727.92 / $858.01
| Professional | | $618.73 | $727.92 | $858.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $394.91 / $770.48 / $1,026.28
| Professional | | $394.91 | $770.48 | $1,026.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.55 / $421.71 / $592.72
| Facility | | $294.55 | $421.71 | $592.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $336.72 / $598.62 / $2,280.16
| Professional | | $336.72 | $598.62 | $2,280.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $336.72 / $595.99 / $740.78
| Professional | | $336.72 | $595.99 | $740.78 |