- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $4,168.69 / $7,079.46
| Facility | | $741.31 | $4,168.69 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $2,041.74 / $4,677.35
| Facility | | $691.83 | $2,041.74 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $707.95 / $1,096.48
| Facility | | $457.09 | $707.95 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $229.09 / $933.25
| Professional | | $177.83 | $229.09 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $154.88 / $154.88 / $194.98
| Professional | 52 | $154.88 | $154.88 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $2,454.71 / $5,248.07
| Facility | | $524.81 | $2,454.71 | $5,248.07 |