- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.98 / $208.93 / $676.08
| Facility | | $194.98 | $208.93 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $245.47 / $588.84
| Professional | | $169.82 | $245.47 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 54
- Low / Median / High Price
- $213.80 / $323.59 / $758.58
| Professional | 54 | $213.80 | $323.59 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $870.96 / $2,137.96
| Facility | | $363.08 | $870.96 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $478.63 / $758.58
| Professional | | $323.59 | $478.63 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 54
- Low / Median / High Price
- $257.04 / $371.54 / $588.84
| Professional | 54 | $257.04 | $371.54 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $776.25 / $1,862.09
| Facility | | $549.54 | $776.25 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $229.09 / $229.09 / $229.09
| Facility | 54 | $229.09 | $229.09 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $630.96 / $954.99
| Professional | | $363.08 | $630.96 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $741.31 / $1,479.11
| Facility | | $602.56 | $741.31 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $549.54 / $851.14
| Professional | | $389.05 | $549.54 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.55 / $363.08 / $630.96
| Facility | | $190.55 | $363.08 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $426.58 / $1,445.44
| Professional | | $204.17 | $426.58 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $1,819.70 / $3,467.37
| Facility | | $602.56 | $1,819.70 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $354.81 / $707.95
| Professional | | $186.21 | $354.81 | $707.95 |