- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $7,943.28 / $14,454.40
| Facility | | $1,584.89 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $9,332.54 / $18,197.01
| Facility | | $7,244.36 | $9,332.54 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,202.26 / $3,715.35
| Facility | | $758.58 | $1,202.26 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $3,090.30 / $3,090.30 / $3,090.30
| Facility | 52 | $3,090.30 | $3,090.30 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.89 / $1,905.46 / $2,630.27
| Professional | | $1,584.89 | $1,905.46 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $4,570.88 / $13,803.84
| Facility | | $3,235.94 | $4,570.88 | $13,803.84 |