- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,095.84 / $2,950.68 / $7,397.00
| Facility | | $1,095.84 | $2,950.68 | $7,397.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $547.92 / $547.92 / $547.92
| Facility | 52 | $547.92 | $547.92 | $547.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $907.79 / $1,165.96 / $5,914.40
| Professional | | $907.79 | $1,165.96 | $5,914.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,509.24 / $10,188.53 / $21,238.15
| Facility | | $4,509.24 | $10,188.53 | $21,238.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,720.07 / $2,690.34 / $3,791.73
| Professional | | $1,720.07 | $2,690.34 | $3,791.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,539.42 / $3,601.22 / $8,663.23
| Facility | | $2,539.42 | $3,601.22 | $8,663.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,031.24 / $3,460.06 / $4,873.22
| Professional | | $2,031.24 | $3,460.06 | $4,873.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,064.37 / $3,292.38 / $6,821.44
| Facility | | $2,064.37 | $3,292.38 | $6,821.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,788.32 / $3,060.35 / $4,055.61
| Professional | | $1,788.32 | $3,060.35 | $4,055.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,268.08 / $2,078.51 / $10,493.00
| Facility | | $1,268.08 | $2,078.51 | $10,493.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,308.09 / $2,598.41 / $5,587.48
| Professional | | $1,308.09 | $2,598.41 | $5,587.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,483.00 / $7,112.00 / $11,165.00
| Facility | | $4,483.00 | $7,112.00 | $11,165.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,265.63 / $2,392.37 / $4,195.91
| Professional | | $1,265.63 | $2,392.37 | $4,195.91 |