- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $146.88 / $992.58 / $2,766.99
| Facility | | $146.88 | $992.58 | $2,766.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $508.00 / $1,474.16 / $2,213.00
| Facility | | $508.00 | $1,474.16 | $2,213.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $94.25 / $94.25 / $94.25
| Facility | 52 | $94.25 | $94.25 | $94.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.47 / $127.27 / $217.34
| Professional | | $104.47 | $127.27 | $217.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $418.00 / $453.00 / $1,330.00
| Facility | | $418.00 | $453.00 | $1,330.00 |