- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $347.61 / $2,663.12 / $5,691.90
| Facility | | $347.61 | $2,663.12 | $5,691.90 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $72.72 / $72.72 / $149.36
| Facility | 52 | $72.72 | $72.72 | $149.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.43 / $298.72 / $627.69
| Professional | | $145.43 | $298.72 | $627.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $414.08 / $3,372.00 / $10,821.00
| Facility | | $414.08 | $3,372.00 | $10,821.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $671.54 / $671.54 / $671.54
| Facility | 52 | $671.54 | $671.54 | $671.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.67 / $566.29 / $2,658.56
| Professional | | $218.67 | $566.29 | $2,658.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $196.07 / $254.89 / $499.98
| Facility | | $196.07 | $254.89 | $499.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.14 / $501.00 / $965.29
| Professional | | $282.14 | $501.00 | $965.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $267.43 / $572.20 / $1,067.52
| Professional | | $267.43 | $572.20 | $1,067.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $172.59 / $357.52 / $6,679.00
| Facility | | $172.59 | $357.52 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $423.76 / $535.47 / $957.38
| Professional | | $423.76 | $535.47 | $957.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.21 / $467.23 / $998.47
| Professional | | $216.21 | $467.23 | $998.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $179.97 / $2,231.48 / $6,496.97
| Facility | | $179.97 | $2,231.48 | $6,496.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.72 / $267.05 / $534.09
| Professional | | $176.72 | $267.05 | $534.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,376.27 / $3,649.00 / $16,394.00
| Facility | | $1,376.27 | $3,649.00 | $16,394.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $671.54 / $671.54 / $671.54
| Facility | 52 | $671.54 | $671.54 | $671.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $437.33 / $919.27 / $2,658.56
| Professional | | $437.33 | $919.27 | $2,658.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,372.00 / $8,425.00
| Facility | | $1,640.00 | $3,372.00 | $8,425.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $424.31 / $630.74 / $1,116.29
| Professional | | $424.31 | $630.74 | $1,116.29 |