- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,683.00 / $8,400.00
| Facility | | $1,000.00 | $3,683.00 | $8,400.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $223.34 / $223.34 / $223.34
| Facility | 52 | $223.34 | $223.34 | $223.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $385.43 / $446.67 / $475.73
| Professional | | $385.43 | $446.67 | $475.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $369.90 / $545.12 / $686.68
| Professional | | $369.90 | $545.12 | $686.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,528.20 / $10,236.61 / $15,969.95
| Facility | | $6,528.20 | $10,236.61 | $15,969.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $408.45 / $549.19 / $610.09
| Professional | | $408.45 | $549.19 | $610.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,545.78 / $2,545.78 / $2,545.78
| Facility | | $2,545.78 | $2,545.78 | $2,545.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $450.80 / $569.91 / $724.13
| Professional | | $450.80 | $569.91 | $724.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.67 / $673.23 / $5,543.93
| Facility | | $446.67 | $673.23 | $5,543.93 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $870.38 / $6,791.96 / $6,791.96
| Facility | 52 | $870.38 | $6,791.96 | $6,791.96 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $108.80 / $849.00 / $849.00
| Facility | AS | $108.80 | $849.00 | $849.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $379.47 / $491.07 / $3,259.28
| Professional | | $379.47 | $491.07 | $3,259.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $884.00 / $3,317.00 / $5,543.93
| Facility | | $884.00 | $3,317.00 | $5,543.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $357.14 / $450.89 / $659.16
| Professional | | $357.14 | $450.89 | $659.16 |