- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $244.70 / $3,993.30 / $7,598.64
| Facility | | $244.70 | $3,993.30 | $7,598.64 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $122.35 / $122.35 / $122.35
| Facility | 52 | $122.35 | $122.35 | $122.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $254.64 / $442.66 / $731.09
| Facility | | $254.64 | $442.66 | $731.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $384.86 / $638.19 / $3,276.96
| Facility | | $384.86 | $638.19 | $3,276.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $308.58 / $422.39 / $505.88
| Professional | | $308.58 | $422.39 | $505.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,714.00 / $2,714.00 / $2,714.00
| Facility | | $2,714.00 | $2,714.00 | $2,714.00 |