- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,496.00 / $5,091.00 / $7,119.04
| Facility | | $3,496.00 | $5,091.00 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.61 / $354.07 / $907.58
| Professional | | $239.61 | $354.07 | $907.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $335.56 / $619.67 / $4,871.77
| Facility | | $335.56 | $619.67 | $4,871.77 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $3,716.72 / $3,716.72 / $3,716.72
| Facility | 52 | $3,716.72 | $3,716.72 | $3,716.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $481.88 / $800.91 / $1,622.05
| Facility | | $481.88 | $800.91 | $1,622.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,770.00 / $4,663.00 / $7,305.00
| Facility | | $1,770.00 | $4,663.00 | $7,305.00 |