- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $5,248.07 / $9,772.37
| Facility | | $1,023.29 | $5,248.07 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $1,348.96 / $3,235.94
| Facility | | $707.95 | $1,348.96 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $575.44 / $1,412.54
| Facility | | $239.88 | $575.44 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $190.55 / $190.55 / $190.55
| Facility | 52 | $190.55 | $190.55 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $218.78 / $251.19
| Professional | | $218.78 | $218.78 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.25 / $204.17 / $331.13
| Facility | | $141.25 | $204.17 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $6,309.57 / $10,000.00
| Facility | | $616.60 | $6,309.57 | $10,000.00 |