- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.42 / $1,518.41 / $3,955.04
| Facility | | $257.42 | $1,518.41 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.38 / $76.06 / $118.09
| Professional | | $43.38 | $76.06 | $118.09 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $16.38 / $32.38 / $59.05
| Professional | 52 | $16.38 | $32.38 | $59.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.51 / $80.31 / $137.34
| Professional | | $36.51 | $80.31 | $137.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.38 / $69.73 / $154.46
| Professional | | $39.38 | $69.73 | $154.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.00 / $1,183.00 / $4,915.00
| Facility | | $540.00 | $1,183.00 | $4,915.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.23 / $109.37 / $165.89
| Professional | | $68.23 | $109.37 | $165.89 |