- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,589.25 / $13,489.63 / $18,197.01
| Facility | | $12,589.25 | $13,489.63 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $691.83 / $2,818.38
| Facility | | $691.83 | $691.83 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $3,388.44 / $3,388.44 / $3,388.44
| Facility | 22 | $3,388.44 | $3,388.44 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $2,238.72 / $2,238.72 / $2,238.72
| Facility | 52 | $2,238.72 | $2,238.72 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $281.84 / $281.84 / $281.84
| Facility | AS | $281.84 | $281.84 | $281.84 |