- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.06 / $274.25 / $505.59
| Professional | | $209.06 | $274.25 | $505.59 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $102.50 / $137.13 / $187.35
| Professional | 52 | $102.50 | $137.13 | $187.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.70 / $336.33 / $554.94
| Professional | | $302.70 | $336.33 | $554.94 |
- 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
- $230.36 / $301.77 / $536.39
| Professional | | $230.36 | $301.77 | $536.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.81 / $330.68 / $467.49
| Professional | | $243.81 | $330.68 | $467.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.85 / $242.94 / $455.26
| Professional | | $184.85 | $242.94 | $455.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.76 / $316.82 / $409.41
| Professional | | $183.76 | $316.82 | $409.41 |