- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $7,943.28 / $16,595.87
| Facility | | $1,230.27 | $7,943.28 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $5,495.41 / $5,495.41
| Facility | | $5,495.41 | $5,495.41 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $575.44 / $1,778.28
| Facility | | $34.67 | $575.44 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $1,412.54 / $1,412.54 / $1,412.54
| Facility | 52 | $1,412.54 | $1,412.54 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $177.83 / $177.83 / $177.83
| Facility | AS | $177.83 | $177.83 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $933.25 / $1,174.90
| Professional | | $933.25 | $933.25 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $1,318.26 / $2,137.96
| Facility | | $870.96 | $1,318.26 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $6,165.95 / $8,912.51
| Facility | | $478.63 | $6,165.95 | $8,912.51 |