- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.07 / $267.47 / $333.90
| Professional | | $209.07 | $267.47 | $333.90 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $94.48 / $134.72 / $151.32
| Professional | 52 | $94.48 | $134.72 | $151.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.17 / $278.69 / $359.15
| Professional | | $253.17 | $278.69 | $359.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $286.64 / $358.48 / $406.22
| Professional | | $286.64 | $358.48 | $406.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.17 / $314.12 / $406.66
| Professional | | $240.17 | $314.12 | $406.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $237.90 / $294.02 / $476.40
| Facility | | $237.90 | $294.02 | $476.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.68 / $285.87 / $1,893.50
| Professional | | $207.68 | $285.87 | $1,893.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.74 / $254.29 / $410.37
| Professional | | $195.74 | $254.29 | $410.37 |