- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $155.07 / $1,730.00 / $4,031.51
| Facility | | $155.07 | $1,730.00 | $4,031.51 |
- Facility/Professional
- Facility
- Modifier
- 25
- Low / Median / High Price
- $543.24 / $2,114.52 / $4,739.10
| Facility | 25 | $543.24 | $2,114.52 | $4,739.10 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $174.09 / $599.66 / $853.16
| Professional | 25 | $174.09 | $599.66 | $853.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,534.00 / $2,245.00 / $3,801.00
| Facility | | $1,534.00 | $2,245.00 | $3,801.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,345.00 / $1,524.00 / $4,400.00
| Facility | | $1,345.00 | $1,524.00 | $4,400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,422.21 / $2,422.21 / $2,582.25
| Facility | | $2,422.21 | $2,422.21 | $2,582.25 |