- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $7,244.36 / $16,982.44
| Facility | | $1,659.59 | $7,244.36 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $1,905.46 / $8,511.38 / $30,902.95
| Facility | 22 | $1,905.46 | $8,511.38 | $30,902.95 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,630.78 / $8,709.64 / $19,054.61
| Facility | 50 | $3,630.78 | $8,709.64 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $2,691.53 / $5,370.32 / $8,128.31
| Facility | 80 | $2,691.53 | $5,370.32 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $10,964.78 / $22,387.21
| Facility | | $3,801.89 | $10,964.78 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $3,090.30 / $19,054.61
| Facility | | $1,122.02 | $3,090.30 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $1,348.96 / $1,348.96 / $1,348.96
| Facility | 22 | $1,348.96 | $1,348.96 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $112.20 / $112.20 / $112.20
| Facility | AS | $112.20 | $112.20 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $8,709.64 / $18,620.87
| Facility | | $3,019.95 | $8,709.64 | $18,620.87 |