- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.50 / $211.37 / $239.17
| Professional | | $152.50 | $211.37 | $239.17 |
- Facility/Professional
- Professional
- Modifier
- 54
- Low / Median / High Price
- $158.53 / $168.67 / $179.38
| Professional | 54 | $158.53 | $168.67 | $179.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $235.52 / $235.52 / $750.72
| Professional | | $235.52 | $235.52 | $750.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.83 / $318.85 / $446.86
| Professional | | $206.83 | $318.85 | $446.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.91 / $294.55 / $446.86
| Professional | | $243.91 | $294.55 | $446.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $228.10 / $280.66 / $815.89
| Professional | | $228.10 | $280.66 | $815.89 |