- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $3,235.94 / $6,760.83
| Facility | | $234.42 | $3,235.94 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,137.96 / $2,137.96
| Facility | | $2,137.96 | $2,137.96 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $281.84 / $891.25
| Professional | | $134.90 | $281.84 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.18 / $331.13 / $5,011.87
| Facility | | $162.18 | $331.13 | $5,011.87 |
- 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
- $275.42 / $346.74 / $371.54
| Professional | | $275.42 | $346.74 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,137.96 / $2,137.96
| Facility | | $2,137.96 | $2,137.96 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $4,786.30 / $6,309.57
| Facility | | $2,511.89 | $4,786.30 | $6,309.57 |