- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $419.61 / $2,747.00 / $5,039.00
| Facility | | $419.61 | $2,747.00 | $5,039.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $61.79 / $61.79 / $209.81
| Facility | 52 | $61.79 | $61.79 | $209.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.58 / $419.61 / $958.43
| Professional | | $123.58 | $419.61 | $958.43 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $61.79 / $209.81 / $479.22
| Professional | 52 | $61.79 | $209.81 | $479.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.78 / $3,245.00 / $7,608.00
| Facility | | $389.78 | $3,245.00 | $7,608.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $687.69 / $687.69 / $687.69
| Facility | 52 | $687.69 | $687.69 | $687.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.02 / $943.22 / $3,434.00
| Professional | | $188.02 | $943.22 | $3,434.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $201.68 / $262.18 / $514.28
| Facility | | $201.68 | $262.18 | $514.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $313.56 / $941.46 / $1,893.55
| Professional | | $313.56 | $941.46 | $1,893.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.35 / $367.74 / $7,218.72
| Facility | | $177.35 | $367.74 | $7,218.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $704.17 / $834.84 / $1,492.63
| Professional | | $704.17 | $834.84 | $1,492.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $217.91 / $697.55 / $1,737.32
| Professional | | $217.91 | $697.55 | $1,737.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $4,287.00 / $9,401.00
| Facility | | $55.00 | $4,287.00 | $9,401.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $687.69 / $687.69 / $687.69
| Facility | 52 | $687.69 | $687.69 | $687.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $895.61 / $1,547.38 / $5,225.72
| Professional | | $895.61 | $1,547.38 | $5,225.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $4,983.00 / $8,810.00
| Facility | | $2,155.00 | $4,983.00 | $8,810.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $746.34 / $1,155.11 / $2,104.59
| Professional | | $746.34 | $1,155.11 | $2,104.59 |