- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,104.00 / $6,405.50 / $11,049.62
| Facility | | $4,104.00 | $6,405.50 | $11,049.62 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $8,625.00 / $8,625.00 / $8,625.00
| Facility | 22 | $8,625.00 | $8,625.00 | $8,625.00 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $6,188.30 / $6,188.30 / $6,188.30
| Facility | 80 | $6,188.30 | $6,188.30 | $6,188.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $651.39 / $1,312.14 / $16,154.25
| Professional | | $651.39 | $1,312.14 | $16,154.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,728.00 / $2,074.00 / $3,209.00
| Professional | | $1,728.00 | $2,074.00 | $3,209.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.57 / $1,101.06 / $1,546.60
| Professional | | $676.57 | $1,101.06 | $1,546.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,934.00 / $6,934.00 / $26,502.00
| Facility | | $6,934.00 | $6,934.00 | $26,502.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $761.82 / $1,216.26 / $2,884.19
| Professional | | $761.82 | $1,216.26 | $2,884.19 |