- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $872.66 / $1,900.00 / $7,721.65
| Facility | | $872.66 | $1,900.00 | $7,721.65 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $3,568.50 / $3,568.50 / $3,568.50
| Facility | 22 | $3,568.50 | $3,568.50 | $3,568.50 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,825.00 / $4,118.66 / $9,324.89
| Facility | 50 | $1,825.00 | $4,118.66 | $9,324.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,638.29 / $6,825.60 / $9,182.62
| Facility | | $5,638.29 | $6,825.60 | $9,182.62 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $8,457.43 / $10,238.40 / $13,773.92
| Facility | 50 | $8,457.43 | $10,238.40 | $13,773.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,125.00 / $5,085.00 / $9,624.00
| Facility | | $2,125.00 | $5,085.00 | $9,624.00 |