- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $266.95 / $266.95 / $3,073.00
| Facility | | $266.95 | $266.95 | $3,073.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $133.47 / $133.47 / $133.47
| Facility | 52 | $133.47 | $133.47 | $133.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $278.58 / $451.16 / $892.81
| Facility | | $278.58 | $451.16 | $892.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $455.04 / $756.62 / $9,874.07
| Facility | | $455.04 | $756.62 | $9,874.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $352.98 / $469.61 / $552.45
| Professional | | $352.98 | $469.61 | $552.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,000.00 / $2,000.00 / $2,000.00
| Facility | | $2,000.00 | $2,000.00 | $2,000.00 |