- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $1,445.44 / $3,235.94
| Facility | | $245.47 | $1,445.44 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $245.47 / $245.47 / $245.47
| Facility | 52 | $245.47 | $245.47 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $239.88 / $602.56
| Professional | | $112.20 | $239.88 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $125.89 / $263.03
| Professional | | $93.33 | $125.89 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,548.82 / $2,137.96
| Facility | | $1,318.26 | $1,548.82 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $269.15 / $380.19
| Professional | | $144.54 | $269.15 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $281.84 / $549.54
| Professional | | $138.04 | $281.84 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $1,659.59 / $3,090.30
| Facility | | $630.96 | $1,659.59 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $223.87 / $426.58
| Professional | | $102.33 | $223.87 | $426.58 |