- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $6,165.95 / $10,232.93
| Facility | | $2,187.76 | $6,165.95 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,995.26 / $5,128.61
| Professional | | $1,318.26 | $1,995.26 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $3,467.37 / $14,125.38
| Facility | | $2,137.96 | $3,467.37 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $5,128.61 / $5,128.61 / $5,128.61
| Facility | 52 | $5,128.61 | $5,128.61 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $645.65 / $645.65 / $645.65
| Facility | AS | $645.65 | $645.65 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,162.28 / $3,801.89
| Professional | | $2,884.03 | $3,162.28 | $3,801.89 |
- 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 |