- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $4,786.30 / $8,511.38
| Facility | | $478.63 | $4,786.30 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $3,890.45 / $7,943.28
| Facility | | $3,090.30 | $3,890.45 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $389.05 / $2,818.38
| Facility | | $213.80 | $389.05 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $3,715.35 / $3,715.35 / $3,715.35
| Facility | 52 | $3,715.35 | $3,715.35 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $549.54 / $707.95
| Professional | | $446.68 | $549.54 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $3,162.28 / $8,128.31
| Facility | | $2,398.83 | $3,162.28 | $8,128.31 |