- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $220.77 / $298.12 / $530.16
| Professional | | $220.77 | $298.12 | $530.16 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $137.74 / $153.12 / $283.32
| Professional | 52 | $137.74 | $153.12 | $283.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $249.26 / $311.58 / $670.05
| Professional | | $249.26 | $311.58 | $670.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.00 / $335.00 / $335.00
| Professional | | $335.00 | $335.00 | $335.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.62 / $305.20 / $452.94
| Professional | | $245.62 | $305.20 | $452.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $205.33 / $252.53 / $415.36
| Professional | | $205.33 | $252.53 | $415.36 |