- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,394.63 / $4,618.24 / $8,735.48
| Facility | | $1,394.63 | $4,618.24 | $8,735.48 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $4,416.93 / $7,282.32 / $7,282.32
| Facility | 52 | $4,416.93 | $7,282.32 | $7,282.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $507.00 / $507.00 / $641.21
| Facility | | $507.00 | $507.00 | $641.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,469.61 / $1,906.56 / $2,475.14
| Professional | | $1,469.61 | $1,906.56 | $2,475.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,169.00 / $2,169.00 / $4,028.00
| Facility | | $2,169.00 | $2,169.00 | $4,028.00 |