- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,906.00 / $4,778.89 / $7,119.04
| Facility | | $2,906.00 | $4,778.89 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $278.27 / $414.60 / $1,427.14
| Professional | | $278.27 | $414.60 | $1,427.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $415.45 / $707.66 / $8,625.21
| Facility | | $415.45 | $707.66 | $8,625.21 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $18,071.64 / $18,071.64 / $18,071.64
| Facility | 52 | $18,071.64 | $18,071.64 | $18,071.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $530.90 / $884.33 / $7,695.66
| Facility | | $530.90 | $884.33 | $7,695.66 |
- 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 |