- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,012.00 / $6,298.62 / $11,100.08
| Facility | | $5,012.00 | $6,298.62 | $11,100.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,638.09 / $2,800.35 / $6,833.78
| Professional | | $1,638.09 | $2,800.35 | $6,833.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,735.07 / $4,255.57 / $14,049.20
| Facility | | $2,735.07 | $4,255.57 | $14,049.20 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $6,418.56 / $6,418.56 / $6,418.56
| Facility | 52 | $6,418.56 | $6,418.56 | $6,418.56 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $802.32 / $802.32 / $802.32
| Facility | AS | $802.32 | $802.32 | $802.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,175.22 / $3,983.80 / $5,210.53
| Facility | | $3,175.22 | $3,983.80 | $5,210.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,542.00 / $13,657.65 / $16,616.96
| Facility | | $9,542.00 | $13,657.65 | $16,616.96 |