- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,224.20 / $16,010.56 / $18,053.93
| Facility | | $12,224.20 | $16,010.56 | $18,053.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $699.00 / $699.00 / $1,391.39
| Facility | | $699.00 | $699.00 | $1,391.39 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $1,091.32 / $1,091.32 / $1,091.32
| Facility | 52 | $1,091.32 | $1,091.32 | $1,091.32 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $272.83 / $272.83 / $272.83
| Facility | 53 | $272.83 | $272.83 | $272.83 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $136.41 / $136.41 / $136.41
| Facility | AS | $136.41 | $136.41 | $136.41 |