- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $2,951.21 / $8,128.31
| Facility | | $263.03 | $2,951.21 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $977.24 / $977.24 / $977.24
| Facility | 52 | $977.24 | $977.24 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $263.03 / $660.69
| Professional | | $128.82 | $263.03 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $4,897.79 / $10,964.78
| Facility | | $1,548.82 | $4,897.79 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $281.84 / $562.34
| Professional | | $147.91 | $281.84 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $933.25 / $6,309.57
| Facility | | $223.87 | $933.25 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $177.83 / $177.83 / $177.83
| Facility | 52 | $177.83 | $177.83 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $302.00 / $645.65
| Professional | | $154.88 | $302.00 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $2,884.03 / $6,309.57
| Facility | | $1,023.29 | $2,884.03 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $251.19 / $501.19
| Professional | | $131.83 | $251.19 | $501.19 |