- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.07 / $140.77 / $144.87
| Professional | | $102.07 | $140.77 | $144.87 |
- Facility/Professional
- Professional
- Modifier
- 54
- Low / Median / High Price
- $105.58 / $106.06 / $108.65
| Professional | 54 | $105.58 | $106.06 | $108.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $546.41 / $546.41 / $699.81
| Facility | | $546.41 | $546.41 | $699.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.85 / $175.47 / $447.14
| Professional | | $148.85 | $175.47 | $447.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.27 / $198.63 / $276.16
| Professional | | $120.27 | $198.63 | $276.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.07 / $180.77 / $276.16
| Professional | | $154.07 | $180.77 | $276.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.69 / $173.46 / $301.70
| Professional | | $140.69 | $173.46 | $301.70 |