- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $490.53 / $727.67 / $903.82
| Professional | | $490.53 | $727.67 | $903.82 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $281.81 / $281.81 / $407.56
| Professional | 52 | $281.81 | $281.81 | $407.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,775.30 / $4,428.47 / $4,711.39
| Facility | | $3,775.30 | $4,428.47 | $4,711.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $708.18 / $708.18 / $1,510.20
| Professional | | $708.18 | $708.18 | $1,510.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $440.99 / $696.20 / $1,510.20
| Professional | | $440.99 | $696.20 | $1,510.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $440.99 / $696.20 / $1,510.20
| Professional | | $440.99 | $696.20 | $1,510.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $589.22 / $622.10 / $1,853.60
| Professional | | $589.22 | $622.10 | $1,853.60 |