- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,401.00 / $9,963.19 / $36,979.22
| Facility | | $3,401.00 | $9,963.19 | $36,979.22 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $13,353.79 / $13,353.79 / $19,183.91
| Facility | 22 | $13,353.79 | $13,353.79 | $19,183.91 |
- 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
- Low / Median / High Price
- $4,880.16 / $15,043.00 / $65,975.00
| Facility | | $4,880.16 | $15,043.00 | $65,975.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,855.00 / $12,742.00 / $23,031.00
| Facility | | $5,855.00 | $12,742.00 | $23,031.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,072.00 / $12,923.00 / $19,866.00
| Facility | | $4,072.00 | $12,923.00 | $19,866.00 |