- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $4,570.88 / $8,317.64
| Facility | | $1,202.26 | $4,570.88 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $2,454.71 / $4,677.35
| Facility | | $831.76 | $2,454.71 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $891.25 / $2,187.76
| Facility | | $512.86 | $891.25 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $309.03 / $851.14
| Professional | | $234.42 | $309.03 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $208.93 / $208.93 / $269.15
| Professional | 52 | $208.93 | $208.93 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $5,888.44 / $7,943.28
| Facility | | $3,235.94 | $5,888.44 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $3,235.94 / $6,606.93
| Facility | | $588.84 | $3,235.94 | $6,606.93 |