- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $57.21 / $770.22 / $2,151.64
| Facility | | $57.21 | $770.22 | $2,151.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $508.00 / $909.33 / $1,530.89
| Facility | | $508.00 | $909.33 | $1,530.89 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $172.10 / $172.10 / $172.10
| Facility | 52 | $172.10 | $172.10 | $172.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.12 / $237.62 / $401.09
| Professional | | $188.12 | $237.62 | $401.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $418.00 / $453.00 / $1,330.00
| Facility | | $418.00 | $453.00 | $1,330.00 |