- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.95 / $675.94 / $6,575.00
| Facility | | $190.95 | $675.94 | $6,575.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $95.48 / $337.97 / $337.97
| Facility | 52 | $95.48 | $337.97 | $337.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.21 / $538.65 / $919.81
| Professional | | $181.21 | $538.65 | $919.81 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $95.48 / $337.97 / $459.91
| Professional | 52 | $95.48 | $337.97 | $459.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,888.65 / $5,014.17 / $11,327.71
| Facility | | $1,888.65 | $5,014.17 | $11,327.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $317.81 / $851.50 / $1,952.34
| Professional | | $317.81 | $851.50 | $1,952.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,475.73 / $2,093.84 / $5,037.03
| Facility | | $1,475.73 | $2,093.84 | $5,037.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.17 / $976.51 / $2,455.52
| Professional | | $398.17 | $976.51 | $2,455.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,162.58 / $1,914.28 / $3,966.16
| Facility | | $1,162.58 | $1,914.28 | $3,966.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $368.12 / $966.84 / $2,133.75
| Professional | | $368.12 | $966.84 | $2,133.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.72 / $1,020.98 / $7,589.09
| Facility | | $302.72 | $1,020.98 | $7,589.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $773.18 / $1,517.69 / $3,434.00
| Professional | | $773.18 | $1,517.69 | $3,434.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,293.00 / $6,652.00 / $9,810.00
| Facility | | $3,293.00 | $6,652.00 | $9,810.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $717.79 / $1,266.09 / $2,584.71
| Professional | | $717.79 | $1,266.09 | $2,584.71 |