- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $1,995.26 / $6,456.54
| Facility | | $478.63 | $1,995.26 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $281.84 / $512.86
| Professional | | $123.03 | $281.84 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.13 / $97.72 / $181.97
| Professional | | $74.13 | $97.72 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $3,890.45 / $6,456.54
| Facility | | $2,511.89 | $3,890.45 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $354.81 / $489.78
| Professional | | $213.80 | $354.81 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $295.12 / $501.19
| Professional | | $194.98 | $295.12 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $602.56 / $4,265.80
| Facility | | $204.17 | $602.56 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $616.60 / $616.60 / $616.60
| Facility | 52 | $616.60 | $616.60 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $467.74 / $2,754.23
| Professional | | $316.23 | $467.74 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $2,089.30 / $4,073.80
| Facility | | $575.44 | $2,089.30 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $302.00 / $512.86
| Professional | | $165.96 | $302.00 | $512.86 |