- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $2,511.89 / $5,623.41
| Facility | | $630.96 | $2,511.89 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $371.54 / $1,862.09
| Professional | | $141.25 | $371.54 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $165.96 / $1,096.48
| Professional | | $83.18 | $165.96 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $1,288.25 / $2,630.27
| Facility | | $549.54 | $1,288.25 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $398.11 / $2,041.74
| Professional | | $162.18 | $398.11 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $977.24 / $1,584.89
| Facility | | $446.68 | $977.24 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $288.40 / $1,819.70
| Professional | | $154.88 | $288.40 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.88 / $549.54 / $2,041.74
| Facility | | $154.88 | $549.54 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $549.54 / $549.54 / $3,715.35
| Facility | 52 | $549.54 | $549.54 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $138.04 / $138.04 / $933.25
| Facility | 53 | $138.04 | $138.04 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $1,230.27 / $7,943.28
| Professional | | $169.82 | $1,230.27 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $1,862.09 / $4,677.35
| Facility | | $977.24 | $1,862.09 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $234.42 / $1,548.82
| Professional | | $144.54 | $234.42 | $1,548.82 |