- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.58 / $271.24 / $377.48
| Professional | | $218.58 | $271.24 | $377.48 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $110.39 / $138.94 / $187.35
| Professional | 52 | $110.39 | $138.94 | $187.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.34 / $390.68 / $567.61
| Professional | | $239.34 | $390.68 | $567.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $333.08 / $333.08 / $333.08
| Facility | | $333.08 | $333.08 | $333.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $261.68 / $332.26 / $484.51
| Professional | | $261.68 | $332.26 | $484.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.87 / $346.96 / $506.14
| Facility | | $275.87 | $346.96 | $506.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $332.60 / $413.58 / $578.44
| Professional | | $332.60 | $413.58 | $578.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.31 / $332.29 / $482.82
| Professional | | $241.31 | $332.29 | $482.82 |