- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,166.58 / $2,429.42 / $3,097.33
| Facility | | $2,166.58 | $2,429.42 | $3,097.33 |
- 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
- $1,366.02 / $1,366.02 / $1,366.02
| Facility | 52 | $1,366.02 | $1,366.02 | $1,366.02 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $170.75 / $170.75 / $170.75
| Facility | AS | $170.75 | $170.75 | $170.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,488.48 / $1,836.15 / $2,646.19
| Professional | | $1,488.48 | $1,836.15 | $2,646.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,236.00 / $1,679.00 / $3,590.00
| Facility | | $1,236.00 | $1,679.00 | $3,590.00 |