- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,950.68 / $9,631.16 / $24,068.03
| Facility | | $2,950.68 | $9,631.16 | $24,068.03 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $479.90 / $479.90 / $479.90
| Facility | 52 | $479.90 | $479.90 | $479.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $959.80 / $1,950.00 / $4,232.00
| Professional | | $959.80 | $1,950.00 | $4,232.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,121.08 / $6,940.38 / $13,028.86
| Facility | | $5,121.08 | $6,940.38 | $13,028.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $918.52 / $1,563.49 / $2,087.55
| Professional | | $918.52 | $1,563.49 | $2,087.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,911.43 / $2,375.37 / $2,938.21
| Professional | | $1,911.43 | $2,375.37 | $2,938.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $959.80 / $1,823.62 / $8,816.00
| Facility | | $959.80 | $1,823.62 | $8,816.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $12,547.52 / $12,547.52 / $12,547.52
| Facility | 52 | $12,547.52 | $12,547.52 | $12,547.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,313.31 / $2,246.46 / $7,671.04
| Professional | | $1,313.31 | $2,246.46 | $7,671.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,911.43 / $2,539.12 / $5,383.60
| Facility | | $1,911.43 | $2,539.12 | $5,383.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,474.91 / $2,237.23 / $2,938.21
| Professional | | $1,474.91 | $2,237.23 | $2,938.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $1,299.00 / $2,708.10
| Professional | | $5.00 | $1,299.00 | $2,708.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,210.00 / $7,221.00 / $8,632.00
| Facility | | $6,210.00 | $7,221.00 | $8,632.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,313.31 / $2,186.66 / $2,658.11
| Professional | | $1,313.31 | $2,186.66 | $2,658.11 |