- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,117.31 / $8,646.91 / $12,764.25
| Facility | | $5,117.31 | $8,646.91 | $12,764.25 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,586.81 / $1,586.81 / $18,884.39
| Facility | AS | $1,586.81 | $1,586.81 | $18,884.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $632.69 / $788.27 / $1,020.83
| Professional | | $632.69 | $788.27 | $1,020.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $756.72 / $892.00 / $1,280.18
| Professional | | $756.72 | $892.00 | $1,280.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $753.07 / $753.07 / $1,545.00
| Facility | | $753.07 | $753.07 | $1,545.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $594.13 / $594.13 / $594.13
| Facility | 52 | $594.13 | $594.13 | $594.13 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $148.53 / $148.53 / $148.53
| Facility | 53 | $148.53 | $148.53 | $148.53 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $74.27 / $74.27 / $74.27
| Facility | AS | $74.27 | $74.27 | $74.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $684.45 / $956.03 / $1,438.84
| Professional | | $684.45 | $956.03 | $1,438.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,761.50 / $10,761.50 / $10,761.50
| Facility | | $10,761.50 | $10,761.50 | $10,761.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $742.82 / $956.69 / $1,497.06
| Professional | | $742.82 | $956.69 | $1,497.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,692.45 / $9,427.37 / $19,499.57
| Facility | | $2,692.45 | $9,427.37 | $19,499.57 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,586.81 / $1,586.81 / $18,884.39
| Facility | AS | $1,586.81 | $1,586.81 | $18,884.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $680.55 / $788.27 / $1,049.28
| Professional | | $680.55 | $788.27 | $1,049.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $652.16 / $917.42 / $1,296.58
| Professional | | $652.16 | $917.42 | $1,296.58 |