- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.58 / $277.73 / $374.70
| Professional | | $218.58 | $277.73 | $374.70 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $102.02 / $137.94 / $173.48
| Professional | 52 | $102.02 | $137.94 | $173.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $252.56 / $276.55 / $280.67
| Professional | | $252.56 | $276.55 | $280.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $230.30 / $391.52 / $391.52
| Facility | | $230.30 | $391.52 | $391.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.35 / $267.82 / $307.55
| Professional | | $234.35 | $267.82 | $307.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.73 / $294.00 / $538.48
| Professional | | $227.73 | $294.00 | $538.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $249.64 / $304.77 / $525.29
| Facility | | $249.64 | $304.77 | $525.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.87 / $257.26 / $1,893.50
| Professional | | $209.87 | $257.26 | $1,893.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.32 / $248.82 / $448.05
| Professional | | $208.32 | $248.82 | $448.05 |