- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $2,818.38 / $8,511.38
| Facility | | $446.68 | $2,818.38 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $616.60 / $616.60 / $616.60
| Facility | 52 | $616.60 | $616.60 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $354.81 / $630.96
| Professional | | $95.50 | $354.81 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $3,715.35 / $9,332.54
| Facility | | $1,548.82 | $3,715.35 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $407.38 / $831.76
| Professional | | $109.65 | $407.38 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $1,412.54 / $3,890.45
| Facility | | $186.21 | $1,412.54 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $147.91 / $147.91 / $147.91
| Facility | 52 | $147.91 | $147.91 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $446.68 / $1,122.02
| Professional | | $131.83 | $446.68 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,949.84 / $4,786.30
| Facility | | $575.44 | $1,949.84 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $354.81 / $851.14
| Professional | | $109.65 | $354.81 | $851.14 |