- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,284.24 / $3,977.01 / $7,878.50
| Facility | | $1,284.24 | $3,977.01 | $7,878.50 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $604.78 / $644.55 / $862.42
| Facility | 52 | $604.78 | $644.55 | $862.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,062.39 / $1,241.21 / $1,978.71
| Professional | | $1,062.39 | $1,241.21 | $1,978.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,302.10 / $5,196.00 / $10,517.23
| Facility | | $3,302.10 | $5,196.00 | $10,517.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,130.14 / $1,482.26 / $2,413.19
| Professional | | $1,130.14 | $1,482.26 | $2,413.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,713.60 / $1,974.25 / $2,196.50
| Facility | | $1,713.60 | $1,974.25 | $2,196.50 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $1,133.07 / $1,133.07 / $1,133.07
| Facility | 52 | $1,133.07 | $1,133.07 | $1,133.07 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $141.63 / $141.63 / $141.63
| Facility | AS | $141.63 | $141.63 | $141.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,195.09 / $1,684.88 / $2,604.48
| Professional | | $1,195.09 | $1,684.88 | $2,604.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,157.50 / $5,179.50 / $9,716.00
| Facility | | $2,157.50 | $5,179.50 | $9,716.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,175.22 / $1,537.98 / $2,678.16
| Professional | | $1,175.22 | $1,537.98 | $2,678.16 |