- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $266.27 / $2,563.00 / $6,298.62
| Facility | | $266.27 | $2,563.00 | $6,298.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.19 / $1,171.05 / $1,621.29
| Professional | | $88.19 | $1,171.05 | $1,621.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $215.83 / $1,607.00 / $3,108.81
| Facility | | $215.83 | $1,607.00 | $3,108.81 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $341.53 / $341.53 / $341.53
| Facility | 52 | $341.53 | $341.53 | $341.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $228.60 / $1,970.10 / $3,423.56
| Facility | | $228.60 | $1,970.10 | $3,423.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,204.00 / $1,607.00 / $2,126.00
| Facility | | $1,204.00 | $1,607.00 | $2,126.00 |