- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $130.94 / $130.94 / $3,073.00
| Facility | | $130.94 | $130.94 | $3,073.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $65.48 / $65.48 / $65.48
| Facility | 52 | $65.48 | $65.48 | $65.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.06 / $237.36 / $405.42
| Facility | | $138.06 | $237.36 | $405.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.03 / $362.75 / $2,030.75
| Facility | | $223.03 | $362.75 | $2,030.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.34 / $240.01 / $273.64
| Professional | | $180.34 | $240.01 | $273.64 |
- 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 |