- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $652.52 / $804.71 / $1,400.00
| Professional | | $652.52 | $804.71 | $1,400.00 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $685.22 / $685.22 / $5,802.03
| Professional | 52 | $685.22 | $685.22 | $5,802.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $654.87 / $973.23 / $1,745.77
| Professional | | $654.87 | $973.23 | $1,745.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $737.61 / $1,056.61 / $1,881.62
| Professional | | $737.61 | $1,056.61 | $1,881.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $424.74 / $820.55 / $1,402.09
| Professional | | $424.74 | $820.55 | $1,402.09 |