- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,235.18 / $4,100.00 / $11,581.00
| Facility | | $1,235.18 | $4,100.00 | $11,581.00 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $13,858.54 / $13,858.54 / $13,858.54
| Facility | 22 | $13,858.54 | $13,858.54 | $13,858.54 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $4,744.24 / $9,665.80 / $24,984.84
| Facility | 50 | $4,744.24 | $9,665.80 | $24,984.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,583.00 / $9,198.00 / $19,252.00
| Facility | | $4,583.00 | $9,198.00 | $19,252.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,825.44 / $3,763.00 / $5,816.26
| Facility | | $2,825.44 | $3,763.00 | $5,816.26 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $122.40 / $122.40 / $122.40
| Facility | AS | $122.40 | $122.40 | $122.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,206.00 / $6,578.00 / $12,241.00
| Facility | | $3,206.00 | $6,578.00 | $12,241.00 |