- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $776.25 / $4,365.16
| Facility | | $213.80 | $776.25 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- 25
- Low / Median / High Price
- $776.25 / $2,630.27 / $6,309.57
| Facility | 25 | $776.25 | $2,630.27 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $251.19 / $812.83
| Professional | | $173.78 | $251.19 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $190.55 / $354.81 / $1,047.13
| Professional | 25 | $190.55 | $354.81 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $2,454.71 / $14,454.40
| Facility | | $263.03 | $2,454.71 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $281.84 / $501.19
| Professional | | $204.17 | $281.84 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $331.13 / $2,398.83
| Facility | | $229.09 | $331.13 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $309.03 / $602.56
| Professional | | $208.93 | $309.03 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $2,187.76 / $3,890.45
| Facility | | $213.80 | $2,187.76 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $275.42 / $478.63
| Professional | | $190.55 | $275.42 | $478.63 |