- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.55 / $676.08 / $1,380.38
| Facility | | $190.55 | $676.08 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $467.74 / $912.01
| Professional | | $181.97 | $467.74 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $6,025.60 / $14,454.40
| Facility | | $2,454.71 | $6,025.60 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $741.31 / $1,778.28
| Professional | | $302.00 | $741.31 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,187.76 / $5,248.07
| Facility | | $1,513.56 | $2,187.76 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $245.47 / $245.47 / $245.47
| Facility | 52 | $245.47 | $245.47 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $933.25 / $2,454.71
| Professional | | $389.05 | $933.25 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,089.30 / $4,168.69
| Facility | | $1,698.24 | $2,089.30 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $1,000.00 / $2,290.87
| Professional | | $380.19 | $1,000.00 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $1,096.48 / $9,332.54
| Facility | | $295.12 | $1,096.48 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,230.27 / $2,818.38
| Professional | | $758.58 | $1,230.27 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $6,025.60 / $10,715.19
| Facility | | $3,019.95 | $6,025.60 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $758.58 / $1,995.26
| Professional | | $269.15 | $758.58 | $1,995.26 |