- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $212.43 / $480.85 / $2,814.48
| Facility | | $212.43 | $480.85 | $2,814.48 |
- Facility/Professional
- Facility
- Modifier
- 25
- Low / Median / High Price
- $738.00 / $2,055.08 / $3,877.70
| Facility | 25 | $738.00 | $2,055.08 | $3,877.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.80 / $231.18 / $353.70
| Professional | | $180.80 | $231.18 | $353.70 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $45.68 / $227.47 / $748.31
| Professional | 25 | $45.68 | $227.47 | $748.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.91 / $203.22 / $335.31
| Professional | | $173.91 | $203.22 | $335.31 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $194.86 / $224.09 / $325.14
| Professional | 25 | $194.86 | $224.09 | $325.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $970.70 / $1,021.79 / $1,021.79
| Facility | | $970.70 | $1,021.79 | $1,021.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $270.72 / $328.12 / $386.02
| Professional | | $270.72 | $328.12 | $386.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,745.00 / $1,745.00 / $1,745.00
| Facility | | $1,745.00 | $1,745.00 | $1,745.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $220.21 / $327.67 / $483.14
| Professional | | $220.21 | $327.67 | $483.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $180.80 / $266.95 / $549.85
| Facility | | $180.80 | $266.95 | $549.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.01 / $402.78 / $1,733.52
| Professional | | $281.01 | $402.78 | $1,733.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $266.64 / $313.11 / $443.41
| Professional | | $266.64 | $313.11 | $443.41 |