- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.88 / $4,897.79 / $7,585.78
| Facility | | $154.88 | $4,897.79 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $8,317.64 / $10,471.29
| Facility | | $2,344.23 | $8,317.64 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.90 / $141.25 / $158.49
| Facility | | $134.90 | $141.25 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $537.03 / $1,148.15
| Facility | | $239.88 | $537.03 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $190.55 / $190.55 / $190.55
| Facility | 52 | $190.55 | $190.55 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $3,715.35 / $6,456.54
| Facility | | $1,412.54 | $3,715.35 | $6,456.54 |