- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $307.02 / $2,815.42 / $5,354.63
| Facility | | $307.02 | $2,815.42 | $5,354.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $629.00 / $1,441.78 / $2,470.35
| Facility | | $629.00 | $1,441.78 | $2,470.35 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $232.05 / $232.05 / $232.05
| Facility | 52 | $232.05 | $232.05 | $232.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.85 / $323.93 / $457.70
| Professional | | $255.85 | $323.93 | $457.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $717.00 / $964.00 / $2,489.00
| Facility | | $717.00 | $964.00 | $2,489.00 |