- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $700.35 / $4,552.18 / $10,196.73
| Facility | | $700.35 | $4,552.18 | $10,196.73 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $3,612.20 / $3,612.20 / $3,612.20
| Facility | 22 | $3,612.20 | $3,612.20 | $3,612.20 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $9,549.12 / $12,262.25 / $12,262.25
| Facility | 50 | $9,549.12 | $12,262.25 | $12,262.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,335.00 / $1,772.93 / $2,985.38
| Facility | | $1,335.00 | $1,772.93 | $2,985.38 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $66.25 / $66.25 / $66.25
| Facility | AS | $66.25 | $66.25 | $66.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $583.63 / $748.28 / $1,037.33
| Professional | | $583.63 | $748.28 | $1,037.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,028.00 / $1,347.00 / $3,219.00
| Facility | | $1,028.00 | $1,347.00 | $3,219.00 |