- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $172.36 / $1,518.41 / $3,955.04
| Facility | | $172.36 | $1,518.41 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.67 / $87.30 / $120.91
| Professional | | $58.67 | $87.30 | $120.91 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $26.92 / $43.65 / $57.98
| Professional | 52 | $26.92 | $43.65 | $57.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.56 / $96.54 / $160.83
| Professional | | $69.56 | $96.54 | $160.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.37 / $119.78 / $229.36
| Professional | | $70.37 | $119.78 | $229.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.00 / $1,401.00 / $4,915.00
| Facility | | $540.00 | $1,401.00 | $4,915.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.42 / $125.43 / $211.65
| Professional | | $64.42 | $125.43 | $211.65 |