- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.14 / $205.61 / $3,706.14
| Facility | | $112.14 | $205.61 | $3,706.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.28 / $42.06 / $74.56
| Professional | | $27.28 | $42.06 | $74.56 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $87.72 / $87.72 / $87.72
| Professional | 50 | $87.72 | $87.72 | $87.72 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $13.64 / $20.93 / $30.12
| Professional | 52 | $13.64 | $20.93 | $30.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.86 / $55.78 / $79.76
| Professional | | $37.86 | $55.78 | $79.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.67 / $68.50 / $112.31
| Professional | | $36.67 | $68.50 | $112.31 |
- 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
- $43.13 / $54.44 / $81.18
| Professional | | $43.13 | $54.44 | $81.18 |