- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.91 / $7,943.28 / $16,595.87
| Facility | | $22.91 | $7,943.28 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $1,023.29 / $2,041.74
| Facility | | $549.54 | $1,023.29 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.36 / $537.03 / $660.69
| Facility | | $32.36 | $537.03 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $26.30 / $26.30 / $26.30
| Facility | 52 | $26.30 | $26.30 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.65 / $43.65 / $48.98
| Professional | | $43.65 | $43.65 | $48.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.50 / $32.36 / $52.48
| Facility | | $19.50 | $32.36 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $6,165.95 / $10,000.00
| Facility | | $616.60 | $6,165.95 | $10,000.00 |