- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $6,165.95 / $15,488.17
| Facility | | $1,445.44 | $6,165.95 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $19,054.61 / $19,054.61 / $19,054.61
| Facility | 22 | $19,054.61 | $19,054.61 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $5,623.41 / $11,748.98 / $23,442.29
| Facility | 50 | $5,623.41 | $11,748.98 | $23,442.29 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $2,137.96 / $2,137.96 / $2,137.96
| Facility | AS | $2,137.96 | $2,137.96 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $8,709.64 / $20,417.38
| Facility | | $3,548.13 | $8,709.64 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $3,090.30 / $9,772.37
| Facility | | $1,230.27 | $3,090.30 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $2,137.96 / $2,137.96 / $2,137.96
| Facility | 22 | $2,137.96 | $2,137.96 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $177.83 / $177.83 / $177.83
| Facility | AS | $177.83 | $177.83 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $8,709.64 / $19,054.61
| Facility | | $3,019.95 | $8,709.64 | $19,054.61 |