- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.08 / $1,410.05 / $2,307.00
| Facility | | $162.08 | $1,410.05 | $2,307.00 |
- Facility/Professional
- Facility
- Modifier
- 25
- Low / Median / High Price
- $48.85 / $1,455.50 / $2,390.00
| Facility | 25 | $48.85 | $1,455.50 | $2,390.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.05 / $44.63 / $103.00
| Professional | | $27.05 | $44.63 | $103.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.78 / $46.45 / $150.94
| Professional | | $39.78 | $46.45 | $150.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.08 / $48.28 / $98.69
| Professional | | $35.08 | $48.28 | $98.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.50 / $43.76 / $91.51
| Facility | | $30.50 | $43.76 | $91.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.52 / $44.90 / $500.00
| Professional | | $35.52 | $44.90 | $500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.09 / $42.02 / $83.64
| Professional | | $35.09 | $42.02 | $83.64 |