- 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
- $17.77 / $33.54 / $112.57
| Professional | | $17.77 | $33.54 | $112.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.64 / $53.56 / $2,855.25
| Facility | | $32.64 | $53.56 | $2,855.25 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $2,165.08 / $2,165.08 / $2,165.08
| Facility | 52 | $2,165.08 | $2,165.08 | $2,165.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35.15 / $54.99 / $916.95
| Facility | | $35.15 | $54.99 | $916.95 |
- 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 |