- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $149.80 / $170.36 / $3,706.14
| Facility | | $149.80 | $170.36 | $3,706.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.69 / $15.49 / $23.03
| Professional | | $11.69 | $15.49 | $23.03 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $17.54 / $17.54 / $34.83
| Professional | 50 | $17.54 | $17.54 | $34.83 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $5.85 / $6.65 / $7.75
| Professional | 52 | $5.85 | $6.65 | $7.75 |
- Facility/Professional
- Professional
- Modifier
- 53
- Low / Median / High Price
- $2.34 / $2.66 / $3.10
| Professional | 53 | $2.34 | $2.66 | $3.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.05 / $18.88 / $18.88
| Professional | | $16.05 | $18.88 | $18.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.93 / $23.98 / $29.09
| Professional | | $11.93 | $23.98 | $29.09 |
- 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
- $11.86 / $20.10 / $32.14
| Professional | | $11.86 | $20.10 | $32.14 |