- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $5,370.32 / $7,943.28
| Facility | | $1,071.52 | $5,370.32 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $1,258.93 / $3,235.94
| Professional | | $741.31 | $1,258.93 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,819.70 / $6,918.31
| Facility | | $1,023.29 | $1,819.70 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $2,754.23 / $2,754.23 / $2,754.23
| Facility | 52 | $2,754.23 | $2,754.23 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,698.24 / $2,290.87
| Professional | | $1,548.82 | $1,698.24 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $5,248.07 / $7,413.10
| Facility | | $2,137.96 | $5,248.07 | $7,413.10 |