- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $8,511.38 / $38,904.51
| Facility | | $6,025.60 | $8,511.38 | $38,904.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,882.50 / $16,982.44 / $33,113.11
| Facility | | $12,882.50 | $16,982.44 | $33,113.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,489.63 / $13,489.63 / $13,489.63
| Facility | | $13,489.63 | $13,489.63 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $2,398.83 / $15,135.61
| Facility | | $1,318.26 | $2,398.83 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $2,951.21 / $5,370.32 / $5,370.32
| Facility | 52 | $2,951.21 | $5,370.32 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $371.54 / $676.08 / $676.08
| Facility | AS | $371.54 | $676.08 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,754.23 / $3,311.31 / $4,570.88
| Professional | | $2,754.23 | $3,311.31 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,489.63 / $13,489.63 / $13,489.63
| Facility | | $13,489.63 | $13,489.63 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $10,000.00 / $16,982.44
| Facility | | $8,317.64 | $10,000.00 | $16,982.44 |