- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $5,011.87 / $12,882.50
| Facility | | $1,258.93 | $5,011.87 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $4,168.69 / $4,168.69 / $4,168.69
| Facility | 22 | $4,168.69 | $4,168.69 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $4,677.35 / $4,677.35 / $4,677.35
| Facility | 80 | $4,677.35 | $4,677.35 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $10,000.00 / $19,952.62
| Facility | | $3,630.78 | $10,000.00 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,584.89 / $6,760.83
| Facility | | $501.19 | $1,584.89 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $1,905.46 / $1,905.46 / $1,905.46
| Facility | 22 | $1,905.46 | $1,905.46 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $158.49 / $158.49 / $158.49
| Facility | AS | $158.49 | $158.49 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $7,762.47 / $17,782.79
| Facility | | $2,137.96 | $7,762.47 | $17,782.79 |