- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $705.16 / $7,838.38 / $7,838.38
| Facility | | $705.16 | $7,838.38 | $7,838.38 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $101.67 / $101.67 / $352.58
| Facility | 52 | $101.67 | $101.67 | $352.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.81 / $538.65 / $705.16
| Professional | | $180.81 | $538.65 | $705.16 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $90.41 / $306.56 / $479.45
| Professional | 52 | $90.41 | $306.56 | $479.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,697.32 / $8,869.91 / $14,859.46
| Facility | | $3,697.32 | $8,869.91 | $14,859.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $268.38 / $527.99 / $1,259.38
| Professional | | $268.38 | $527.99 | $1,259.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.50 / $352.08 / $1,039.66
| Professional | | $218.50 | $352.08 | $1,039.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $160.24 / $838.55
| Professional | | $32.34 | $160.24 | $838.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $310.22 / $886.33 / $1,128.06
| Facility | | $310.22 | $886.33 | $1,128.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.50 / $352.08 / $1,039.66
| Professional | | $218.50 | $352.08 | $1,039.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,602.00 / $9,127.00 / $10,150.00
| Facility | | $6,602.00 | $9,127.00 | $10,150.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $669.68 / $894.50 / $1,363.55
| Professional | | $669.68 | $894.50 | $1,363.55 |