- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.10 / $615.76 / $8,028.45
| Facility | | $549.10 | $615.76 | $8,028.45 |
- Facility/Professional
- Facility
- Modifier
- 25
- Low / Median / High Price
- $847.43 / $1,630.38 / $1,978.74
| Facility | 25 | $847.43 | $1,630.38 | $1,978.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.09 / $239.91 / $967.20
| Professional | | $192.09 | $239.91 | $967.20 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $194.00 / $625.66 / $1,208.40
| Professional | 25 | $194.00 | $625.66 | $1,208.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $247.18 / $431.17 / $606.88
| Professional | | $247.18 | $431.17 | $606.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $222.77 / $343.09 / $472.63
| Facility | | $222.77 | $343.09 | $472.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $317.39 / $496.12 / $1,733.52
| Professional | | $317.39 | $496.12 | $1,733.52 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $407.85 / $526.41 / $726.00
| Professional | 25 | $407.85 | $526.41 | $726.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.29 / $420.15 / $540.47
| Facility | | $346.29 | $420.15 | $540.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $308.58 / $422.39 / $525.46
| Professional | | $308.58 | $422.39 | $525.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.50 / $411.43 / $550.02
| Professional | | $275.50 | $411.43 | $550.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $296.64 / $463.04 / $566.26
| Professional | | $296.64 | $463.04 | $566.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $374.70 / $411.20 / $498.20
| Professional | | $374.70 | $411.20 | $498.20 |