- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.27 / $7,508.16 / $15,792.65
| Facility | | $1,905.27 | $7,508.16 | $15,792.65 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $10,766.10 / $10,766.10 / $10,766.10
| Facility | 22 | $10,766.10 | $10,766.10 | $10,766.10 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $5,776.38 / $9,580.40 / $16,328.72
| Facility | 50 | $5,776.38 | $9,580.40 | $16,328.72 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $17,002.13 / $17,002.13 / $17,002.13
| Facility | AS | $17,002.13 | $17,002.13 | $17,002.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,093.00 / $10,099.00 / $17,774.00
| Facility | | $6,093.00 | $10,099.00 | $17,774.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,210.44 / $4,967.35 / $6,702.00
| Facility | | $2,210.44 | $4,967.35 | $6,702.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $103.83 / $103.83 / $103.83
| Facility | AS | $103.83 | $103.83 | $103.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $8,072.00 / $14,242.22
| Facility | | $3,028.00 | $8,072.00 | $14,242.22 |