- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $98.25 / $294.05 / $6,907.00
| Facility | | $98.25 | $294.05 | $6,907.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $1,787.10 / $1,787.10 / $1,787.10
| Facility | 52 | $1,787.10 | $1,787.10 | $1,787.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.54 / $109.56 / $114.42
| Professional | | $81.54 | $109.56 | $114.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.25 / $134.62 / $163.87
| Professional | | $76.25 | $134.62 | $163.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $241.53 / $602.00 / $723.89
| Facility | | $241.53 | $602.00 | $723.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.86 / $130.10 / $185.85
| Professional | | $89.86 | $130.10 | $185.85 |