- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $118.07 / $376.67 / $1,918.92
| Facility | | $118.07 | $376.67 | $1,918.92 |
- Facility/Professional
- Facility
- Modifier
- 25
- Low / Median / High Price
- $822.13 / $1,762.33 / $3,115.19
| Facility | 25 | $822.13 | $1,762.33 | $3,115.19 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $159.75 / $483.27 / $908.20
| Professional | 25 | $159.75 | $483.27 | $908.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $465.48 / $540.88 / $1,748.98
| Facility | | $465.48 | $540.88 | $1,748.98 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $218.66 / $353.21 / $433.06
| Professional | 25 | $218.66 | $353.21 | $433.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $415.02 / $593.61 / $1,416.57
| Facility | | $415.02 | $593.61 | $1,416.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $377.29 / $484.62 / $1,115.41
| Facility | | $377.29 | $484.62 | $1,115.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $157.41 / $266.04 / $733.14
| Facility | | $157.41 | $266.04 | $733.14 |
- Facility/Professional
- Facility
- Modifier
- 25
- Low / Median / High Price
- $1,189.50 / $1,514.40 / $2,370.50
| Facility | 25 | $1,189.50 | $1,514.40 | $2,370.50 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $374.32 / $537.41 / $916.20
| Professional | 25 | $374.32 | $537.41 | $916.20 |