- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,150.00 / $2,556.00 / $5,923.00
| Facility | | $1,150.00 | $2,556.00 | $5,923.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $136.46 / $136.46 / $136.46
| Facility | 52 | $136.46 | $136.46 | $136.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,072.00 / $3,931.00 / $5,258.00
| Facility | | $3,072.00 | $3,931.00 | $5,258.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $909.22 / $1,186.98 / $1,269.31
| Facility | | $909.22 | $1,186.98 | $1,269.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.40 / $318.36 / $1,214.02
| Professional | | $227.40 | $318.36 | $1,214.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.86 / $2,096.52 / $2,096.52
| Facility | | $933.86 | $2,096.52 | $2,096.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $721.00 / $2,200.00 / $6,317.00
| Facility | | $721.00 | $2,200.00 | $6,317.00 |