- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35.00 / $305.10 / $3,362.43
| Facility | | $35.00 | $305.10 | $3,362.43 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $239.40 / $2,521.67 / $3,530.58
| Facility | 50 | $239.40 | $2,521.67 | $3,530.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.07 / $42.57 / $51.58
| Professional | | $27.07 | $42.57 | $51.58 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $58.64 / $110.29 / $110.29
| Professional | 50 | $58.64 | $110.29 | $110.29 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $15.15 / $17.50 / $25.41
| Professional | 52 | $15.15 | $17.50 | $25.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.61 / $48.86 / $83.06
| Professional | | $33.61 | $48.86 | $83.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $243.56 / $1,710.47 / $1,767.36
| Facility | | $243.56 | $1,710.47 | $1,767.36 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $111.71 / $111.71 / $2,302.44
| Facility | 50 | $111.71 | $111.71 | $2,302.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.30 / $61.41 / $109.54
| Professional | | $47.30 | $61.41 | $109.54 |