- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $103.52 / $440.25 / $2,168.00
| Facility | | $103.52 | $440.25 | $2,168.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $51.76 / $220.13 / $220.13
| Facility | 52 | $51.76 | $220.13 | $220.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.52 / $428.41 / $658.43
| Professional | | $103.52 | $428.41 | $658.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.17 / $1,224.06 / $2,500.33
| Facility | | $524.17 | $1,224.06 | $2,500.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.56 / $560.41 / $1,455.38
| Professional | | $193.56 | $560.41 | $1,455.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,086.52 / $1,540.82 / $3,706.65
| Facility | | $1,086.52 | $1,540.82 | $3,706.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.62 / $727.96 / $1,818.56
| Professional | | $255.62 | $727.96 | $1,818.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $883.26 / $1,408.68 / $2,918.63
| Facility | | $883.26 | $1,408.68 | $2,918.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $224.07 / $715.93 / $1,580.00
| Professional | | $224.07 | $715.93 | $1,580.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $164.08 / $696.26 / $2,327.69
| Facility | | $164.08 | $696.26 | $2,327.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $662.00 / $1,330.43 / $1,930.42
| Professional | | $662.00 | $1,330.43 | $1,930.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,755.00 / $2,872.00 / $4,241.00
| Facility | | $1,755.00 | $2,872.00 | $4,241.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $566.25 / $1,028.69 / $1,855.54
| Professional | | $566.25 | $1,028.69 | $1,855.54 |