- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,199.25 / $1,199.25 / $6,955.00
| Facility | | $1,199.25 | $1,199.25 | $6,955.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $599.63 / $599.63 / $599.63
| Facility | 52 | $599.63 | $599.63 | $599.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,110.58 / $1,211.20 / $1,893.75
| Professional | | $1,110.58 | $1,211.20 | $1,893.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,463.42 / $5,762.11 / $12,749.70
| Facility | | $2,463.42 | $5,762.11 | $12,749.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,003.74 / $2,779.33 / $4,456.60
| Professional | | $2,003.74 | $2,779.33 | $4,456.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,014.46 / $4,274.88 / $10,283.81
| Facility | | $3,014.46 | $4,274.88 | $10,283.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,070.21 / $3,558.09 / $5,338.38
| Professional | | $2,070.21 | $3,558.09 | $5,338.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,450.54 / $3,908.27 / $8,097.49
| Facility | | $2,450.54 | $3,908.27 | $8,097.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,036.77 / $3,069.19 / $4,880.85
| Professional | | $2,036.77 | $3,069.19 | $4,880.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,316.46 / $2,037.96 / $5,499.00
| Facility | | $1,316.46 | $2,037.96 | $5,499.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,499.87 / $2,566.58 / $5,126.85
| Professional | | $1,499.87 | $2,566.58 | $5,126.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,293.00 / $6,652.00 / $9,810.00
| Facility | | $3,293.00 | $6,652.00 | $9,810.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,499.87 / $2,443.91 / $4,926.97
| Professional | | $1,499.87 | $2,443.91 | $4,926.97 |