- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $614.30 / $2,986.00 / $7,467.00
| Facility | | $614.30 | $2,986.00 | $7,467.00 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $2,503.50 / $2,503.50 / $2,503.50
| Facility | 22 | $2,503.50 | $2,503.50 | $2,503.50 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,072.31 / $2,831.25 / $7,793.02
| Facility | 50 | $1,072.31 | $2,831.25 | $7,793.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,321.00 / $7,362.00 / $16,083.00
| Facility | | $3,321.00 | $7,362.00 | $16,083.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,555.20 / $3,349.99 / $4,217.67
| Facility | | $2,555.20 | $3,349.99 | $4,217.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,637.00 / $5,735.00 / $9,622.00
| Facility | | $2,637.00 | $5,735.00 | $9,622.00 |