- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $161.72 / $1,363.00 / $4,547.72
| Facility | | $161.72 | $1,363.00 | $4,547.72 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $52.83 / $134.25 / $1,215.47
| Facility | 52 | $52.83 | $134.25 | $1,215.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $576.29 / $1,232.72 / $2,468.52
| Facility | | $576.29 | $1,232.72 | $2,468.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $875.00 / $7,701.00 / $11,011.00
| Facility | | $875.00 | $7,701.00 | $11,011.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.27 / $1,306.17 / $2,276.71
| Professional | | $133.27 | $1,306.17 | $2,276.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.00 / $900.00 / $3,686.00
| Facility | | $165.00 | $900.00 | $3,686.00 |