- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $161.12 / $589.17 / $5,123.38
| Facility | | $161.12 | $589.17 | $5,123.38 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $80.56 / $294.58 / $294.58
| Facility | 52 | $80.56 | $294.58 | $294.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.12 / $269.35 / $996.87
| Professional | | $161.12 | $269.35 | $996.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $836.19 / $3,084.88 / $6,762.24
| Facility | | $836.19 | $3,084.88 | $6,762.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $344.08 / $852.90 / $2,016.37
| Professional | | $344.08 | $852.90 | $2,016.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,265.38 / $2,122.51 / $5,105.99
| Facility | | $1,265.38 | $2,122.51 | $5,105.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.71 / $853.27 / $2,475.55
| Professional | | $363.71 | $853.27 | $2,475.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,091.43 / $1,871.36 / $4,020.46
| Facility | | $1,091.43 | $1,871.36 | $4,020.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $360.11 / $876.47 / $2,150.21
| Professional | | $360.11 | $876.47 | $2,150.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $224.31 / $520.70 / $1,754.43
| Facility | | $224.31 | $520.70 | $1,754.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $601.48 / $1,426.30 / $4,363.52
| Professional | | $601.48 | $1,426.30 | $4,363.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,224.00 / $3,500.00 / $6,361.00
| Facility | | $1,224.00 | $3,500.00 | $6,361.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $577.26 / $1,188.25 / $2,338.92
| Professional | | $577.26 | $1,188.25 | $2,338.92 |