- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.15 / $489.78 / $489.78
| Facility | | $107.15 | $489.78 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $309.03 / $870.96
| Professional | | $114.82 | $309.03 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,951.21 / $8,511.38
| Facility | | $1,862.09 | $2,951.21 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $575.44 / $1,584.89
| Professional | | $208.93 | $575.44 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,862.09 / $4,466.84
| Facility | | $1,148.15 | $1,862.09 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $158.49 / $158.49 / $158.49
| Facility | 52 | $158.49 | $158.49 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $575.44 / $1,819.70
| Professional | | $218.78 | $575.44 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,778.28 / $3,467.37
| Facility | | $1,445.44 | $1,778.28 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $776.25 / $1,819.70
| Professional | | $251.19 | $776.25 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.82 / $371.54 / $1,412.54
| Facility | | $128.82 | $371.54 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $1,071.52 / $3,630.78
| Professional | | $446.68 | $1,071.52 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $3,019.95 / $6,456.54
| Facility | | $1,445.44 | $3,019.95 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $467.74 / $1,513.56
| Professional | | $134.90 | $467.74 | $1,513.56 |