- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $45.71 / $5,370.32 / $9,549.93
| Facility | | $45.71 | $5,370.32 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $1,819.70 / $3,548.13
| Facility | | $549.54 | $1,819.70 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $537.03 / $776.25
| Facility | | $380.19 | $537.03 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.60 / $21.88 / $74.13
| Professional | | $16.60 | $21.88 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $15.14 / $15.14 / $19.50
| Professional | 52 | $15.14 | $15.14 | $19.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $2,454.71 / $5,248.07
| Facility | | $524.81 | $2,454.71 | $5,248.07 |