- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $108.95 / $491.46 / $2,042.00
| Facility | | $108.95 | $491.46 | $2,042.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $54.48 / $245.73 / $245.73
| Facility | 52 | $54.48 | $245.73 | $245.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.95 / $195.88 / $818.06
| Professional | | $108.95 | $195.88 | $818.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,533.65 / $2,631.94 / $5,194.88
| Facility | | $1,533.65 | $2,631.94 | $5,194.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.17 / $679.34 / $1,670.45
| Professional | | $229.17 | $679.34 | $1,670.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,134.17 / $1,770.15 / $4,258.34
| Facility | | $1,134.17 | $1,770.15 | $4,258.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $246.15 / $731.56 / $2,060.80
| Professional | | $246.15 | $731.56 | $2,060.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $982.86 / $1,615.38 / $3,353.03
| Facility | | $982.86 | $1,615.38 | $3,353.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.71 / $783.93 / $1,789.97
| Professional | | $243.71 | $783.93 | $1,789.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.86 / $354.88 / $1,402.33
| Facility | | $151.86 | $354.88 | $1,402.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $542.42 / $1,345.72 / $3,618.00
| Professional | | $542.42 | $1,345.72 | $3,618.00 |
- 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
- $542.42 / $1,109.88 / $2,180.94
| Professional | | $542.42 | $1,109.88 | $2,180.94 |