- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $5,248.07 / $12,589.25
| Facility | | $954.99 | $5,248.07 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $2,754.23 / $3,890.45 / $4,570.88
| Facility | 22 | $2,754.23 | $3,890.45 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,090.30 / $7,585.78 / $15,135.61
| Facility | 50 | $3,090.30 | $7,585.78 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $8,511.38 / $16,218.10
| Facility | | $3,311.31 | $8,511.38 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $1,737.80 / $4,466.84
| Facility | | $831.76 | $1,737.80 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $1,202.26 / $1,202.26 / $1,202.26
| Facility | 22 | $1,202.26 | $1,202.26 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | AS | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $5,011.87 / $12,022.64
| Facility | | $1,348.96 | $5,011.87 | $12,022.64 |