- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $5,128.61 / $13,803.84
| Facility | | $1,174.90 | $5,128.61 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $11,220.18 / $13,489.63 / $13,489.63
| Facility | 22 | $11,220.18 | $13,489.63 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,995.26 / $6,606.93 / $19,498.45
| Facility | 50 | $1,995.26 | $6,606.93 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $4,168.69 / $4,168.69 / $4,168.69
| Facility | 80 | $4,168.69 | $4,168.69 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $10,232.93 / $21,379.62
| Facility | | $3,467.37 | $10,232.93 | $21,379.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $2,818.38 / $7,943.28
| Facility | | $1,258.93 | $2,818.38 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $1,949.84 / $1,949.84 / $1,949.84
| Facility | 22 | $1,949.84 | $1,949.84 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $162.18 / $162.18 / $162.18
| Facility | AS | $162.18 | $162.18 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $5,754.40 / $14,125.38
| Facility | | $1,995.26 | $5,754.40 | $14,125.38 |