- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $3,467.37 / $10,964.78
| Facility | | $616.60 | $3,467.37 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $2,511.89 / $2,511.89 / $19,952.62
| Facility | 22 | $2,511.89 | $2,511.89 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $891.25 / $3,235.94 / $10,715.19
| Facility | 50 | $891.25 | $3,235.94 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $8,511.38 / $18,197.01
| Facility | | $3,019.95 | $8,511.38 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $2,691.53 / $19,952.62
| Facility | | $645.65 | $2,691.53 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $776.25 / $776.25 / $776.25
| Facility | 22 | $776.25 | $776.25 | $776.25 |
- 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 |