- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $238.57 / $1,322.70 / $10,000.00
| Facility | | $238.57 | $1,322.70 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $119.29 / $119.29 / $661.35
| Facility | 52 | $119.29 | $119.29 | $661.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.15 / $1,128.96 / $1,468.03
| Professional | | $198.15 | $1,128.96 | $1,468.03 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $119.29 / $661.35 / $691.52
| Professional | 52 | $119.29 | $661.35 | $691.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $460.93 / $1,914.38 / $2,661.82
| Professional | | $460.93 | $1,914.38 | $2,661.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $286.83 / $690.94 / $2,922.43
| Professional | | $286.83 | $690.94 | $2,922.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $238.57 / $1,322.70 / $2,248.59
| Facility | | $238.57 | $1,322.70 | $2,248.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,334.59 / $2,426.48 / $3,475.75
| Professional | | $1,334.59 | $2,426.48 | $3,475.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,345.91 / $2,426.48 / $3,475.75
| Professional | | $1,345.91 | $2,426.48 | $3,475.75 |