- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,506.15 / $4,241.22 / $13,841.56
| Facility | | $1,506.15 | $4,241.22 | $13,841.56 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $50.75 / $50.75 / $203.12
| Facility | 52 | $50.75 | $50.75 | $203.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.49 / $406.23 / $597.50
| Professional | | $101.49 | $406.23 | $597.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,229.71 / $1,666.57 / $3,128.57
| Facility | | $1,229.71 | $1,666.57 | $3,128.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.87 / $240.62 / $806.69
| Professional | | $105.87 | $240.62 | $806.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $260.56 / $912.67 / $1,340.18
| Professional | | $260.56 | $912.67 | $1,340.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $129.40 / $517.94 / $1,172.14
| Facility | | $129.40 | $517.94 | $1,172.14 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $388.74 / $388.74 / $388.74
| Facility | 52 | $388.74 | $388.74 | $388.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $553.61 / $1,027.76 / $1,515.67
| Professional | | $553.61 | $1,027.76 | $1,515.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $267.07 / $794.67 / $1,340.18
| Facility | | $267.07 | $794.67 | $1,340.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $233.62 / $794.67 / $1,266.79
| Professional | | $233.62 | $794.67 | $1,266.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.00 / $549.79 / $1,236.40
| Professional | | $7.00 | $549.79 | $1,236.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,775.00 / $3,227.00 / $6,169.00
| Facility | | $1,775.00 | $3,227.00 | $6,169.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $699.04 / $1,024.17 / $1,067.23
| Professional | | $699.04 | $1,024.17 | $1,067.23 |