- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $5,888.44 / $14,125.38
| Facility | | $1,412.54 | $5,888.44 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $2,454.71 / $4,466.84 / $8,128.31
| Facility | 52 | $2,454.71 | $4,466.84 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,258.93 / $3,890.45
| Professional | | $912.01 | $1,258.93 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $7,762.47 / $16,982.44
| Facility | | $3,388.44 | $7,762.47 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,288.25 / $2,454.71
| Professional | | $891.25 | $1,288.25 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,311.31 / $9,120.11
| Facility | | $1,698.24 | $3,311.31 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $1,348.96 / $1,348.96 / $1,348.96
| Facility | 52 | $1,348.96 | $1,348.96 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,513.56 / $3,311.31
| Professional | | $912.01 | $1,513.56 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $7,244.36 / $16,218.10
| Facility | | $2,511.89 | $7,244.36 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,202.26 / $2,290.87
| Professional | | $831.76 | $1,202.26 | $2,290.87 |