- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $297.54 / $467.02 / $467.02
| Facility | | $297.54 | $467.02 | $467.02 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $223.16 / $223.16 / $350.27
| Facility | 54 | $223.16 | $223.16 | $350.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $411.25 / $683.78 / $1,142.76
| Facility | | $411.25 | $683.78 | $1,142.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $499.47 / $709.65 / $1,193.79
| Facility | | $499.47 | $709.65 | $1,193.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $476.36 / $629.73 / $941.24
| Professional | | $476.36 | $629.73 | $941.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $821.00 / $821.00 / $821.00
| Facility | | $821.00 | $821.00 | $821.00 |