- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $185.05 / $621.16 / $2,568.96
| Facility | | $185.05 | $621.16 | $2,568.96 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $92.53 / $310.58 / $310.58
| Facility | 52 | $92.53 | $310.58 | $310.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.05 / $307.01 / $1,056.34
| Professional | | $185.05 | $307.01 | $1,056.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $940.96 / $3,130.18 / $6,762.24
| Facility | | $940.96 | $3,130.18 | $6,762.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $387.96 / $897.92 / $2,125.61
| Professional | | $387.96 | $897.92 | $2,125.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,435.70 / $2,240.76 / $5,390.45
| Facility | | $1,435.70 | $2,240.76 | $5,390.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $409.30 / $986.73 / $2,607.07
| Professional | | $409.30 | $986.73 | $2,607.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,152.24 / $1,975.62 / $4,244.45
| Facility | | $1,152.24 | $1,975.62 | $4,244.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $413.95 / $1,023.22 / $2,269.88
| Professional | | $413.95 | $1,023.22 | $2,269.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $265.82 / $589.04 / $1,795.14
| Facility | | $265.82 | $589.04 | $1,795.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $641.82 / $1,585.57 / $4,612.72
| Professional | | $641.82 | $1,585.57 | $4,612.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,260.00 / $2,523.00 / $4,637.00
| Facility | | $1,260.00 | $2,523.00 | $4,637.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $673.61 / $1,322.71 / $2,603.61
| Professional | | $673.61 | $1,322.71 | $2,603.61 |