- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.18 / $1,000.00 / $3,981.07
| Facility | | $162.18 | $1,000.00 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- 25
- Low / Median / High Price
- $602.56 / $1,513.56 / $5,248.07
| Facility | 25 | $602.56 | $1,513.56 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $151.36 / $338.84 / $851.14
| Professional | 25 | $151.36 | $338.84 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $2,570.40 / $16,982.44
| Facility | | $1,348.96 | $2,570.40 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $691.83 / $4,570.88
| Facility | | $269.15 | $691.83 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.04 / $1,621.81 / $3,162.28
| Facility | | $138.04 | $1,621.81 | $3,162.28 |