- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.34 / $232.62 / $736.48
| Professional | | $199.34 | $232.62 | $736.48 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $116.31 / $116.31 / $368.24
| Professional | 52 | $116.31 | $116.31 | $368.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $256.61 / $815.58 / $2,186.23
| Professional | | $256.61 | $815.58 | $2,186.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $256.61 / $815.58 / $2,186.23
| Professional | | $256.61 | $815.58 | $2,186.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $833.14 / $901.71 / $2,683.35
| Professional | | $833.14 | $901.71 | $2,683.35 |