- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,012.00 / $6,298.62 / $11,265.38
| Facility | | $5,012.00 | $6,298.62 | $11,265.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,775.69 / $3,060.95 / $8,093.02
| Professional | | $1,775.69 | $3,060.95 | $8,093.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,968.28 / $4,903.53 / $12,871.00
| Facility | | $2,968.28 | $4,903.53 | $12,871.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $6,958.71 / $6,958.71 / $6,958.71
| Facility | 52 | $6,958.71 | $6,958.71 | $6,958.71 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $869.84 / $869.84 / $869.84
| Facility | AS | $869.84 | $869.84 | $869.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,439.69 / $4,339.35 / $5,675.58
| Facility | | $3,439.69 | $4,339.35 | $5,675.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,352.00 / $13,970.00 / $16,616.96
| Facility | | $10,352.00 | $13,970.00 | $16,616.96 |