- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $4,073.80 / $10,715.19
| Facility | | $831.76 | $4,073.80 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $5,623.41 / $5,888.44 / $12,589.25
| Facility | 22 | $5,623.41 | $5,888.44 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $11,220.18 / $11,220.18 / $11,220.18
| Facility | 80 | $11,220.18 | $11,220.18 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $5,623.41 / $5,623.41 / $5,623.41
| Facility | AS | $5,623.41 | $5,623.41 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $707.95 / $2,570.40
| Professional | | $229.09 | $707.95 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $9,332.54 / $17,782.79
| Facility | | $3,388.44 | $9,332.54 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $831.76 / $1,548.82
| Professional | | $562.34 | $831.76 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $1,862.09 / $11,481.54
| Facility | | $933.25 | $1,862.09 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $1,202.26 / $1,202.26 / $1,202.26
| Facility | 22 | $1,202.26 | $1,202.26 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | AS | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $912.01 / $1,949.84
| Professional | | $588.84 | $912.01 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $8,317.64 / $17,782.79
| Facility | | $2,691.53 | $8,317.64 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $741.31 / $1,380.38
| Professional | | $524.81 | $741.31 | $1,380.38 |