- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.94 / $315.86 / $359.95
| Professional | | $227.94 | $315.86 | $359.95 |
- Facility/Professional
- Professional
- Modifier
- 54
- Low / Median / High Price
- $236.90 / $254.08 / $269.95
| Professional | 54 | $236.90 | $254.08 | $269.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $612.01 / $612.01 / $783.79
| Facility | | $612.01 | $612.01 | $783.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $303.88 / $303.88 / $1,124.06
| Professional | | $303.88 | $303.88 | $1,124.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $312.89 / $474.99 / $671.12
| Professional | | $312.89 | $474.99 | $671.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $349.63 / $435.98 / $671.12
| Professional | | $349.63 | $435.98 | $671.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $315.22 / $414.66 / $1,225.41
| Professional | | $315.22 | $414.66 | $1,225.41 |