- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $220.77 / $282.17 / $460.66
| Professional | | $220.77 | $282.17 | $460.66 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $111.47 / $141.09 / $171.35
| Professional | 52 | $111.47 | $141.09 | $171.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $252.56 / $272.42 / $407.36
| Professional | | $252.56 | $272.42 | $407.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.64 / $221.05 / $332.41
| Professional | | $181.64 | $221.05 | $332.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $271.57 / $353.04 / $407.36
| Facility | | $271.57 | $353.04 | $407.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.57 / $325.88 / $407.36
| Professional | | $271.57 | $325.88 | $407.36 |
- 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
- $233.55 / $306.52 / $486.93
| Professional | | $233.55 | $306.52 | $486.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.79 / $244.44 / $360.45
| Professional | | $202.79 | $244.44 | $360.45 |