- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.88 / $7,943.28 / $14,454.40
| Facility | | $33.88 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,995.26 / $3,890.45
| Facility | | $1,548.82 | $1,995.26 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.78 / $33.11 / $1,548.82
| Facility | | $17.78 | $33.11 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $2,187.76 / $2,187.76 / $2,187.76
| Facility | 52 | $2,187.76 | $2,187.76 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.31 / $45.71 / $60.26
| Professional | | $36.31 | $45.71 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $3,162.28 / $8,128.31
| Facility | | $1,122.02 | $3,162.28 | $8,128.31 |