- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $7,762.47 / $20,892.96
| Facility | | $1,905.46 | $7,762.47 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $3,311.31 / $4,466.84 / $10,715.19
| Facility | 22 | $3,311.31 | $4,466.84 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $4,570.88 / $9,549.93 / $26,302.68
| Facility | 50 | $4,570.88 | $9,549.93 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $89.13 / $89.13 / $1,047.13
| Facility | AS | $89.13 | $89.13 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $645.65 / $1,737.80
| Professional | | $380.19 | $645.65 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $9,772.37 / $19,952.62
| Facility | | $3,467.37 | $9,772.37 | $19,952.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $512.86 / $933.25
| Professional | | $363.08 | $512.86 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $1,513.56 / $10,715.19
| Facility | | $616.60 | $1,513.56 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $891.25 / $891.25 / $891.25
| Facility | 22 | $891.25 | $891.25 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $74.13 / $74.13 / $74.13
| Facility | AS | $74.13 | $74.13 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $588.84 / $1,230.27
| Professional | | $398.11 | $588.84 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $7,762.47 / $17,782.79
| Facility | | $2,137.96 | $7,762.47 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $489.78 / $891.25
| Professional | | $354.81 | $489.78 | $891.25 |