- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $582.00 / $629.00 / $2,530.00
| Facility | | $582.00 | $629.00 | $2,530.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $1,570.62 / $1,570.62 / $1,570.62
| Facility | 52 | $1,570.62 | $1,570.62 | $1,570.62 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $196.33 / $196.33 / $196.33
| Facility | AS | $196.33 | $196.33 | $196.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,724.12 / $2,114.41 / $2,958.31
| Professional | | $1,724.12 | $2,114.41 | $2,958.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $303.00 / $362.00 / $1,109.00
| Facility | | $303.00 | $362.00 | $1,109.00 |