- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,210.10 / $5,076.00 / $10,382.20
| Facility | | $1,210.10 | $5,076.00 | $10,382.20 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $7,428.97 / $7,428.97 / $7,428.97
| Facility | 22 | $7,428.97 | $7,428.97 | $7,428.97 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,306.75 / $6,073.51 / $13,425.11
| Facility | 50 | $2,306.75 | $6,073.51 | $13,425.11 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $4,148.00 / $4,148.00 / $4,148.00
| Facility | 80 | $4,148.00 | $4,148.00 | $4,148.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,583.00 / $9,030.00 / $17,951.00
| Facility | | $4,583.00 | $9,030.00 | $17,951.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,108.48 / $3,400.69 / $4,442.56
| Facility | | $3,108.48 | $3,400.69 | $4,442.56 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $107.67 / $107.67 / $107.67
| Facility | AS | $107.67 | $107.67 | $107.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,637.00 / $5,735.00 / $9,949.00
| Facility | | $2,637.00 | $5,735.00 | $9,949.00 |