- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $225.68 / $2,788.16 / $2,788.16
| Facility | | $225.68 | $2,788.16 | $2,788.16 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $112.84 / $112.84 / $363.13
| Facility | 52 | $112.84 | $112.84 | $363.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.71 / $662.39 / $1,182.90
| Professional | | $211.71 | $662.39 | $1,182.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $437.26 / $620.40 / $1,792.92
| Professional | | $437.26 | $620.40 | $1,792.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.17 / $713.79 / $1,896.07
| Professional | | $318.17 | $713.79 | $1,896.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $225.68 / $685.68 / $1,343.56
| Facility | | $225.68 | $685.68 | $1,343.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $628.33 / $1,259.14 / $2,720.91
| Professional | | $628.33 | $1,259.14 | $2,720.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $681.00 / $681.00 / $681.00
| Facility | | $681.00 | $681.00 | $681.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $607.14 / $1,181.22 / $1,661.37
| Professional | | $607.14 | $1,181.22 | $1,661.37 |