- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $6,165.95 / $10,232.93
| Facility | | $2,951.21 | $6,165.95 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $2,691.53 / $8,511.38
| Professional | | $1,778.28 | $2,691.53 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $5,011.87 / $15,488.17
| Facility | | $2,951.21 | $5,011.87 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $6,918.31 / $6,918.31 / $6,918.31
| Facility | 52 | $6,918.31 | $6,918.31 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $870.96 / $870.96 / $870.96
| Facility | AS | $870.96 | $870.96 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,981.07 / $4,570.88 / $5,128.61
| Professional | | $3,981.07 | $4,570.88 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,471.29 / $16,218.10 / $34,673.69
| Facility | | $10,471.29 | $16,218.10 | $34,673.69 |