- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.28 / $242.45 / $9,540.61
| Facility | | $147.28 | $242.45 | $9,540.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.31 / $94.34 / $100.84
| Professional | | $57.31 | $94.34 | $100.84 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $28.66 / $30.86 / $48.60
| Professional | 52 | $28.66 | $30.86 | $48.60 |
- Facility/Professional
- Professional
- Modifier
- 53
- Low / Median / High Price
- $11.46 / $12.34 / $19.44
| Professional | 53 | $11.46 | $12.34 | $19.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.81 / $110.71 / $158.19
| Professional | | $80.81 | $110.71 | $158.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $252.85 / $252.85 / $252.85
| Facility | | $252.85 | $252.85 | $252.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.40 / $130.74 / $221.77
| Professional | | $97.40 | $130.74 | $221.77 |