- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $7,413.10 / $14,791.08
| Facility | | $1,230.27 | $7,413.10 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $5,011.87 / $5,011.87 / $5,011.87
| Facility | 52 | $5,011.87 | $5,011.87 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $3,801.89 / $3,801.89 / $3,801.89
| Facility | 80 | $3,801.89 | $3,801.89 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,762.47 / $15,135.61 / $28,183.83
| Facility | | $7,762.47 | $15,135.61 | $28,183.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $794.33 / $4,365.16
| Facility | | $794.33 | $794.33 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $977.24 / $2,630.27
| Professional | | $676.08 | $977.24 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $13,803.84 / $20,417.38
| Facility | | $8,709.64 | $13,803.84 | $20,417.38 |