- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.62 / $244.17 / $301.33
| Professional | | $60.62 | $244.17 | $301.33 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $110.39 / $122.36 / $162.91
| Professional | 52 | $110.39 | $122.36 | $162.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $531.67 / $608.42 / $676.03
| Facility | | $531.67 | $608.42 | $676.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.92 / $334.83 / $392.92
| Professional | | $241.92 | $334.83 | $392.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,066.16 / $1,066.16 / $1,066.16
| Facility | | $1,066.16 | $1,066.16 | $1,066.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.67 / $363.95 / $684.76
| Professional | | $245.67 | $363.95 | $684.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.40 / $289.69 / $475.97
| Professional | | $219.40 | $289.69 | $475.97 |