- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $3,235.94 / $6,760.83
| Facility | | $478.63 | $3,235.94 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,715.19 / $10,715.19 / $10,715.19
| Facility | | $10,715.19 | $10,715.19 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $501.19 / $1,445.44
| Professional | | $269.15 | $501.19 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $676.08 / $14,454.40
| Facility | | $288.40 | $676.08 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $18,197.01 / $18,197.01 / $18,197.01
| Facility | 52 | $18,197.01 | $18,197.01 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $676.08 / $794.33
| Professional | | $616.60 | $676.08 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,715.19 / $10,715.19 / $10,715.19
| Facility | | $10,715.19 | $10,715.19 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $5,495.41 / $15,848.93
| Facility | | $2,570.40 | $5,495.41 | $15,848.93 |