- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $214.46 / $214.46 / $3,073.00
| Facility | | $214.46 | $214.46 | $3,073.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $107.23 / $107.23 / $107.23
| Facility | 52 | $107.23 | $107.23 | $107.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $224.40 / $396.18 / $657.53
| Facility | | $224.40 | $396.18 | $657.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $366.17 / $606.74 / $2,030.75
| Facility | | $366.17 | $606.74 | $2,030.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $294.52 / $390.37 / $445.07
| Professional | | $294.52 | $390.37 | $445.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,000.00 / $2,000.00 / $2,000.00
| Facility | | $2,000.00 | $2,000.00 | $2,000.00 |