- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $458.34 / $2,434.00 / $6,209.00
| Facility | | $458.34 | $2,434.00 | $6,209.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $101.52 / $259.85 / $493.17
| Facility | 52 | $101.52 | $259.85 | $493.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $989.09 / $2,795.56 / $6,315.83
| Facility | | $989.09 | $2,795.56 | $6,315.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,034.12 / $2,034.12 / $2,034.12
| Facility | | $2,034.12 | $2,034.12 | $2,034.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.83 / $473.89 / $980.55
| Professional | | $196.83 | $473.89 | $980.55 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $125.06 / $125.06 / $301.08
| Professional | 52 | $125.06 | $125.06 | $301.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,519.00 / $6,351.00 / $8,836.00
| Facility | | $1,519.00 | $6,351.00 | $8,836.00 |