- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.18 / $1,202.26 / $6,309.57
| Facility | | $162.18 | $1,202.26 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $354.81 / $1,071.52
| Professional | | $165.96 | $354.81 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $3,801.89 / $8,709.64
| Facility | | $1,071.52 | $3,801.89 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $741.31 / $1,949.84
| Professional | | $316.23 | $741.31 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,238.72 / $5,370.32
| Facility | | $1,380.38 | $2,238.72 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $239.88 / $239.88 / $239.88
| Facility | 52 | $239.88 | $239.88 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $776.25 / $2,454.71
| Professional | | $323.59 | $776.25 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,137.96 / $4,168.69
| Facility | | $1,737.80 | $2,137.96 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $870.96 / $1,995.26
| Professional | | $371.54 | $870.96 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $549.54 / $1,778.28
| Facility | | $186.21 | $549.54 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $1,122.02 / $4,365.16
| Professional | | $478.63 | $1,122.02 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $3,467.37 / $6,456.54
| Facility | | $1,445.44 | $3,467.37 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $588.84 / $1,698.24
| Professional | | $194.98 | $588.84 | $1,698.24 |