- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,592.75 / $7,188.50 / $16,159.10
| Facility | | $1,592.75 | $7,188.50 | $16,159.10 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $15,777.91 / $15,777.91 / $15,777.91
| Facility | 22 | $15,777.91 | $15,777.91 | $15,777.91 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $7,734.66 / $7,734.66 / $7,734.66
| Facility | 80 | $7,734.66 | $7,734.66 | $7,734.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,432.00 / $9,458.00 / $17,933.32
| Facility | | $4,432.00 | $9,458.00 | $17,933.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,314.66 / $3,626.26 / $4,798.32
| Facility | | $3,314.66 | $3,626.26 | $4,798.32 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $102.86 / $102.86 / $102.86
| Facility | AS | $102.86 | $102.86 | $102.86 |
- 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 |