- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,277.00 / $5,549.00 / $11,100.08
| Facility | | $4,277.00 | $5,549.00 | $11,100.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $700.48 / $1,096.02 / $1,819.92
| Professional | | $700.48 | $1,096.02 | $1,819.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,021.97 / $1,820.40 / $6,997.36
| Facility | | $1,021.97 | $1,820.40 | $6,997.36 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $2,767.26 / $2,767.26 / $2,767.26
| Facility | 52 | $2,767.26 | $2,767.26 | $2,767.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,127.81 / $1,663.02 / $2,220.04
| Facility | | $1,127.81 | $1,663.02 | $2,220.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,126.00 / $5,847.00 / $7,305.00
| Facility | | $2,126.00 | $5,847.00 | $7,305.00 |