- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.80 / $227.34 / $259.52
| Professional | | $163.80 | $227.34 | $259.52 |
- Facility/Professional
- Professional
- Modifier
- 54
- Low / Median / High Price
- $170.51 / $183.05 / $194.65
| Professional | 54 | $170.51 | $183.05 | $194.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $929.16 / $929.16 / $935.65
| Facility | | $929.16 | $929.16 | $935.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $317.97 / $374.82 / $806.77
| Professional | | $317.97 | $374.82 | $806.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.44 / $354.68 / $496.02
| Professional | | $218.44 | $354.68 | $496.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $265.45 / $325.89 / $496.02
| Professional | | $265.45 | $325.89 | $496.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $258.77 / $311.54 / $905.67
| Professional | | $258.77 | $311.54 | $905.67 |