- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $132.51 / $340.45 / $1,200.00
| Facility | | $132.51 | $340.45 | $1,200.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.51 / $332.97 / $675.08
| Professional | | $132.51 | $332.97 | $675.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $155.28 / $185.80 / $255.80
| Facility | | $155.28 | $185.80 | $255.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.16 / $165.16 / $165.16
| Professional | | $165.16 | $165.16 | $165.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $248.99 / $248.99 / $248.99
| Facility | | $248.99 | $248.99 | $248.99 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $199.19 / $199.19 / $199.19
| Facility | 52 | $199.19 | $199.19 | $199.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.21 / $373.62 / $775.16
| Professional | | $154.21 | $373.62 | $775.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $825.43 / $825.43 / $7,957.50
| Facility | | $825.43 | $825.43 | $7,957.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $299.30 / $467.88 / $708.46
| Professional | | $299.30 | $467.88 | $708.46 |