- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,977.71 / $8,810.03 / $11,100.08
| Facility | | $1,977.71 | $8,810.03 | $11,100.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $613.79 / $1,082.67 / $2,215.01
| Professional | | $613.79 | $1,082.67 | $2,215.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,447.58 / $2,226.69 / $25,336.55
| Facility | | $1,447.58 | $2,226.69 | $25,336.55 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $21,057.68 / $21,057.68 / $21,057.68
| Facility | 52 | $21,057.68 | $21,057.68 | $21,057.68 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $2,632.21 / $2,632.21 / $2,632.21
| Facility | AS | $2,632.21 | $2,632.21 | $2,632.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,383.68 / $2,025.18 / $8,854.25
| Facility | | $1,383.68 | $2,025.18 | $8,854.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,220.00 / $9,346.00 / $14,242.22
| Facility | | $8,220.00 | $9,346.00 | $14,242.22 |