- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $1,288.25 / $3,890.45
| Facility | | $295.12 | $1,288.25 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $128.82 / $275.42
| Professional | | $95.50 | $128.82 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $309.03 / $309.03 / $309.03
| Professional | 52 | $309.03 | $309.03 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $501.19 / $776.25
| Facility | | $218.78 | $501.19 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $154.88 / $208.93
| Professional | | $117.49 | $154.88 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $39.81 / $104.71
| Facility | | $39.81 | $39.81 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $398.11 / $398.11
| Facility | | $398.11 | $398.11 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $151.36 / $218.78
| Professional | | $107.15 | $151.36 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $501.19 / $1,202.26
| Facility | | $213.80 | $501.19 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $123.03 / $223.87
| Professional | | $91.20 | $123.03 | $223.87 |