- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,266.71 / $4,447.00 / $10,202.00
| Facility | | $1,266.71 | $4,447.00 | $10,202.00 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $4,129.52 / $4,129.52 / $4,129.52
| Facility | 22 | $4,129.52 | $4,129.52 | $4,129.52 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $4,698.56 / $4,698.56 / $4,698.56
| Facility | 80 | $4,698.56 | $4,698.56 | $4,698.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,104.00 / $9,256.00 / $16,131.00
| Facility | | $3,104.00 | $9,256.00 | $16,131.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $928.00 / $1,047.98 / $2,651.90
| Facility | | $928.00 | $1,047.98 | $2,651.90 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $102.97 / $102.97 / $102.97
| Facility | AS | $102.97 | $102.97 | $102.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,194.50 / $6,927.00 / $13,246.50
| Facility | | $2,194.50 | $6,927.00 | $13,246.50 |