- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,012.00 / $6,298.62 / $10,255.42
| Facility | | $5,012.00 | $6,298.62 | $10,255.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,423.19 / $2,449.02 / $5,702.76
| Professional | | $1,423.19 | $2,449.02 | $5,702.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,375.36 / $3,896.75 / $12,871.00
| Facility | | $2,375.36 | $3,896.75 | $12,871.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $5,576.91 / $5,576.91 / $5,576.91
| Facility | 52 | $5,576.91 | $5,576.91 | $5,576.91 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $697.11 / $697.11 / $697.11
| Facility | AS | $697.11 | $697.11 | $697.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,756.84 / $3,465.84 / $4,533.07
| Facility | | $2,756.84 | $3,465.84 | $4,533.07 |
- 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 |