- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,964.00 / $6,066.00 / $7,119.04
| Facility | | $4,964.00 | $6,066.00 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $786.20 / $1,220.28 / $2,524.00
| Professional | | $786.20 | $1,220.28 | $2,524.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,090.34 / $1,853.19 / $4,495.54
| Facility | | $1,090.34 | $1,853.19 | $4,495.54 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $3,102.73 / $3,102.73 / $3,102.73
| Facility | 52 | $3,102.73 | $3,102.73 | $3,102.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,274.39 / $1,864.62 / $2,507.86
| Facility | | $1,274.39 | $1,864.62 | $2,507.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,966.00 / $6,110.41 / $7,407.10
| Facility | | $1,966.00 | $6,110.41 | $7,407.10 |