- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,439.98 / $6,313.74 / $12,435.50
| Facility | | $1,439.98 | $6,313.74 | $12,435.50 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $9,010.97 / $9,010.97 / $12,734.50
| Facility | 22 | $9,010.97 | $9,010.97 | $12,734.50 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $3,230.00 / $3,230.00 / $3,230.00
| Facility | 80 | $3,230.00 | $3,230.00 | $3,230.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,392.00 / $9,458.00 / $18,458.00
| Facility | | $4,392.00 | $9,458.00 | $18,458.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,016.21 / $4,105.82 / $6,572.11
| Facility | | $3,016.21 | $4,105.82 | $6,572.11 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $80.19 / $80.19 / $80.19
| Facility | AS | $80.19 | $80.19 | $80.19 |
- 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 |