- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,346.77 / $8,950.05 / $21,823.81
| Facility | | $2,346.77 | $8,950.05 | $21,823.81 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $7,457.00 / $11,067.94 / $12,143.04
| Facility | 22 | $7,457.00 | $11,067.94 | $12,143.04 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $450.00 / $450.00 / $450.00
| Facility | 80 | $450.00 | $450.00 | $450.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $602.53 / $602.53 / $602.53
| Facility | AS | $602.53 | $602.53 | $602.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,989.00 / $11,764.00 / $22,609.00
| Facility | | $4,989.00 | $11,764.00 | $22,609.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,151.33 / $6,561.47 / $8,005.08
| Facility | | $5,151.33 | $6,561.47 | $8,005.08 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $102.27 / $102.27 / $102.27
| Facility | AS | $102.27 | $102.27 | $102.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,062.00 / $8,220.00 / $14,242.22
| Facility | | $4,062.00 | $8,220.00 | $14,242.22 |