- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.48 / $240.35 / $1,728.00
| Facility | | $20.48 | $240.35 | $1,728.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.74 / $20.48 / $27.64
| Professional | | $12.74 | $20.48 | $27.64 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $6.37 / $10.24 / $10.24
| Professional | 52 | $6.37 | $10.24 | $10.24 |
- Facility/Professional
- Professional
- Modifier
- 53
- Low / Median / High Price
- $2.54 / $4.09 / $4.09
| Professional | 53 | $2.54 | $4.09 | $4.09 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $19.67 / $19.67 / $23.27
| Professional | 50 | $19.67 | $19.67 | $23.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $148.28 / $179.50 / $241.49
| Facility | | $148.28 | $179.50 | $241.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.07 / $13.79 / $16.27
| Professional | | $10.07 | $13.79 | $16.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.57 / $15.67 / $42.49
| Professional | | $13.57 | $15.67 | $42.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $241.00 / $850.00 / $1,349.00
| Facility | | $241.00 | $850.00 | $1,349.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.83 / $12.77 / $20.73
| Professional | | $10.83 | $12.77 | $20.73 |