- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,762.48 / $6,560.00 / $14,023.00
| Facility | | $1,762.48 | $6,560.00 | $14,023.00 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $30,667.27 / $30,667.27 / $30,667.27
| Facility | 22 | $30,667.27 | $30,667.27 | $30,667.27 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,138.68 / $8,046.10 / $12,268.30
| Facility | 50 | $1,138.68 | $8,046.10 | $12,268.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,905.10 / $6,234.25 / $10,065.60
| Facility | | $2,905.10 | $6,234.25 | $10,065.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,160.00 / $11,160.00 / $11,160.00
| Facility | | $11,160.00 | $11,160.00 | $11,160.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $635.79 / $1,123.78 / $15,451.00
| Facility | | $635.79 | $1,123.78 | $15,451.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,269.00 / $6,170.00 / $12,989.00
| Facility | | $2,269.00 | $6,170.00 | $12,989.00 |