- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $60.15 / $60.15 / $2,168.00
| Facility | | $60.15 | $60.15 | $2,168.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $30.08 / $30.08 / $30.08
| Facility | 52 | $30.08 | $30.08 | $30.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.31 / $62.77 / $134.26
| Professional | | $57.31 | $62.77 | $134.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $397.72 / $1,554.06 / $3,239.20
| Facility | | $397.72 | $1,554.06 | $3,239.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.58 / $173.67 / $221.72
| Professional | | $110.58 | $173.67 | $221.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.53 / $215.00 / $517.21
| Facility | | $151.53 | $215.00 | $517.21 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $56.37 / $56.37 / $56.37
| Facility | 52 | $56.37 | $56.37 | $56.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.13 / $187.16 / $273.81
| Professional | | $118.13 | $187.16 | $273.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $137.75 / $196.56 / $407.25
| Facility | | $137.75 | $196.56 | $407.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.78 / $164.84 / $251.10
| Professional | | $104.78 | $164.84 | $251.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $70.67 / $134.71 / $1,755.00
| Facility | | $70.67 | $134.71 | $1,755.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $157.69 / $157.69 / $157.69
| Facility | 52 | $157.69 | $157.69 | $157.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.06 / $141.93 / $249.36
| Professional | | $71.06 | $141.93 | $249.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,187.00 / $2,872.00 / $4,241.00
| Facility | | $1,187.00 | $2,872.00 | $4,241.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.06 / $137.99 / $242.14
| Professional | | $71.06 | $137.99 | $242.14 |