- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.98 / $2,570.40 / $8,511.38
| Facility | | $194.98 | $2,570.40 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,398.83 / $4,677.35
| Facility | | $1,862.09 | $2,398.83 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.20 / $1,288.25 / $3,019.95
| Facility | | $112.20 | $1,288.25 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $338.84 / $338.84 / $338.84
| Facility | 52 | $338.84 | $338.84 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $2,187.76 / $3,388.44
| Professional | | $229.09 | $2,187.76 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,548.82 / $4,570.88
| Facility | | $1,096.48 | $1,548.82 | $4,570.88 |