- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.80 / $310.69 / $404.68
| Professional | | $223.80 | $310.69 | $404.68 |
- Facility/Professional
- Professional
- Modifier
- 54
- Low / Median / High Price
- $233.02 / $257.02 / $303.51
| Professional | 54 | $233.02 | $257.02 | $303.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $806.03 / $806.03 / $974.22
| Facility | | $806.03 | $806.03 | $974.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $384.21 / $452.90 / $1,264.99
| Professional | | $384.21 | $452.90 | $1,264.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $353.22 / $533.80 / $751.53
| Professional | | $353.22 | $533.80 | $751.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $360.05 / $456.12 / $751.53
| Professional | | $360.05 | $456.12 | $751.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $344.99 / $472.02 / $1,372.21
| Professional | | $344.99 | $472.02 | $1,372.21 |