- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.03 / $277.89 / $377.87
| Professional | | $204.03 | $277.89 | $377.87 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $96.91 / $142.13 / $179.94
| Professional | 52 | $96.91 | $142.13 | $179.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $248.79 / $272.42 / $321.62
| Professional | | $248.79 | $272.42 | $321.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.00 / $400.00 / $472.00
| Professional | | $292.00 | $400.00 | $472.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.75 / $306.14 / $641.15
| Professional | | $225.75 | $306.14 | $641.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.03 / $232.56 / $320.93
| Professional | | $171.03 | $232.56 | $320.93 |