- 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
- $1,648.76 / $1,648.76 / $1,648.76
| Facility | 52 | $1,648.76 | $1,648.76 | $1,648.76 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $206.10 / $206.10 / $206.10
| Facility | AS | $206.10 | $206.10 | $206.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,811.70 / $2,219.29 / $3,124.79
| Professional | | $1,811.70 | $2,219.29 | $3,124.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $303.00 / $413.00 / $1,234.00
| Facility | | $303.00 | $413.00 | $1,234.00 |