- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.23 / $912.01 / $2,884.03
| Facility | | $120.23 | $912.01 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- 25
- Low / Median / High Price
- $478.63 / $1,000.00 / $3,019.95
| Facility | 25 | $478.63 | $1,000.00 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $123.03 / $407.38
| Professional | | $87.10 | $123.03 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $97.72 / $229.09 / $645.65
| Professional | 25 | $97.72 | $229.09 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $2,511.89 / $13,182.57
| Facility | | $1,318.26 | $2,511.89 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $144.54 / $275.42
| Professional | | $102.33 | $144.54 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $501.19 / $3,467.37
| Facility | | $186.21 | $501.19 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $154.88 / $338.84
| Professional | | $104.71 | $154.88 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $95.50 / $1,122.02 / $2,187.76
| Facility | | $95.50 | $1,122.02 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $131.83 / $245.47
| Professional | | $95.50 | $131.83 | $245.47 |