- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $533.37 / $8,498.95 / $9,988.59
| Facility | | $533.37 | $8,498.95 | $9,988.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.54 / $323.77 / $1,382.49
| Professional | | $207.54 | $323.77 | $1,382.49 |
- Facility/Professional
- Professional
- Modifier
- 53
- Low / Median / High Price
- $41.51 / $46.55 / $276.50
| Professional | 53 | $41.51 | $46.55 | $276.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.64 / $343.98 / $1,902.31
| Professional | | $257.64 | $343.98 | $1,902.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,838.43 / $8,767.60 / $15,819.91
| Facility | | $5,838.43 | $8,767.60 | $15,819.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $293.02 / $1,384.45 / $3,206.10
| Professional | | $293.02 | $1,384.45 | $3,206.10 |