- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.32 / $354.30 / $3,955.04
| Facility | | $16.32 | $354.30 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.76 / $4.37 / $7.40
| Professional | | $1.76 | $4.37 | $7.40 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $0.88 / $2.19 / $3.80
| Professional | 52 | $0.88 | $2.19 | $3.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.00 / $4.05 / $9.57
| Professional | | $2.00 | $4.05 | $9.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.06 / $6.49 / $12.31
| Professional | | $2.06 | $6.49 | $12.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.00 / $1,401.00 / $4,915.00
| Facility | | $540.00 | $1,401.00 | $4,915.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.22 / $8.99 / $13.26
| Professional | | $5.22 | $8.99 | $13.26 |