- 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 / $1,819.70
| Facility | | $691.83 | $691.83 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $2,187.76 / $2,187.76 / $2,187.76
| Facility | 22 | $2,187.76 | $2,187.76 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $1,479.11 / $1,479.11 / $1,479.11
| Facility | 52 | $1,479.11 | $1,479.11 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $181.97 / $181.97 / $181.97
| Facility | AS | $181.97 | $181.97 | $181.97 |