- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $1,071.52 / $2,041.74
| Facility | | $416.87 | $1,071.52 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $933.25 / $933.25 / $933.25
| Facility | 52 | $933.25 | $933.25 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $602.56 / $954.99
| Professional | | $251.19 | $602.56 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $346.74 / $954.99
| Professional | | $218.78 | $346.74 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,096.48 / $1,513.56
| Facility | | $1,096.48 | $1,096.48 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $363.08 / $912.01
| Professional | | $275.42 | $363.08 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $512.86 / $912.01
| Facility | | $489.78 | $512.86 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $524.81 / $1,096.48
| Professional | | $281.84 | $524.81 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $467.74 / $1,096.48
| Professional | | $398.11 | $467.74 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $1,288.25 / $3,388.44
| Facility | | $537.03 | $1,288.25 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $575.44 / $1,023.29
| Professional | | $257.04 | $575.44 | $1,023.29 |