- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $5,248.07 / $14,454.40
| Facility | | $1,288.25 | $5,248.07 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $13,182.57 / $13,182.57 / $14,454.40
| Facility | 22 | $13,182.57 | $13,182.57 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $4,265.80 / $10,000.00 / $29,512.09
| Facility | 50 | $4,265.80 | $10,000.00 | $29,512.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $10,471.29 / $21,877.62
| Facility | | $3,548.13 | $10,471.29 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $3,890.45 / $14,125.38
| Facility | | $1,862.09 | $3,890.45 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $2,238.72 / $2,238.72 / $2,238.72
| Facility | 22 | $2,238.72 | $2,238.72 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $186.21 / $186.21 / $186.21
| Facility | AS | $186.21 | $186.21 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $7,244.36 / $16,595.87
| Facility | | $2,511.89 | $7,244.36 | $16,595.87 |