- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $265.08 / $510.15 / $1,398.72
| Facility | | $265.08 | $510.15 | $1,398.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.50 / $64.26 / $131.31
| Professional | | $29.50 | $64.26 | $131.31 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $14.75 / $22.85 / $41.51
| Professional | 52 | $14.75 | $22.85 | $41.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.56 / $38.56 / $47.12
| Facility | | $28.56 | $38.56 | $47.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.27 / $155.44 / $161.09
| Professional | | $34.27 | $155.44 | $161.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51.00 / $51.00 / $51.00
| Facility | | $51.00 | $51.00 | $51.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.27 / $93.85 / $226.80
| Professional | | $34.27 | $93.85 | $226.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $259.00 / $709.47 / $2,862.15
| Facility | | $259.00 | $709.47 | $2,862.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.44 / $98.77 / $158.47
| Professional | | $56.44 | $98.77 | $158.47 |