- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $73.39 / $1,370.26 / $4,589.21
| Facility | | $73.39 | $1,370.26 | $4,589.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $582.00 / $4,332.60 / $6,644.00
| Facility | | $582.00 | $4,332.60 | $6,644.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $191.49 / $191.49 / $191.49
| Facility | 52 | $191.49 | $191.49 | $191.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.71 / $265.31 / $447.03
| Professional | | $207.71 | $265.31 | $447.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,028.00 / $1,347.00 / $3,219.00
| Facility | | $1,028.00 | $1,347.00 | $3,219.00 |