- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.05 / $4,592.00 / $6,915.00
| Facility | | $323.05 | $4,592.00 | $6,915.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $102.78 / $338.43 / $545.55
| Facility | 52 | $102.78 | $338.43 | $545.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.91 / $618.36 / $1,410.70
| Professional | | $186.91 | $618.36 | $1,410.70 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $98.48 / $309.18 / $598.78
| Professional | 52 | $98.48 | $309.18 | $598.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,206.01 / $3,801.18 / $6,973.59
| Facility | | $1,206.01 | $3,801.18 | $6,973.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $232.55 / $572.80 / $1,403.22
| Professional | | $232.55 | $572.80 | $1,403.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,882.00 / $10,446.00 / $11,874.00
| Facility | | $5,882.00 | $10,446.00 | $11,874.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $232.16 / $553.29 / $1,461.83
| Professional | | $232.16 | $553.29 | $1,461.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.44 / $606.47 / $2,667.65
| Professional | | $208.44 | $606.47 | $2,667.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,519.00 / $6,689.00 / $10,000.00
| Facility | | $1,519.00 | $6,689.00 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.41 / $925.57 / $1,631.39
| Professional | | $630.41 | $925.57 | $1,631.39 |