- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $441.46 / $2,396.86 / $8,942.40
| Facility | | $441.46 | $2,396.86 | $8,942.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.00 / $1,167.98 / $3,767.35
| Professional | | $207.00 | $1,167.98 | $3,767.35 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $149.69 / $364.45 / $1,883.68
| Professional | 52 | $149.69 | $364.45 | $1,883.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $334.65 / $457.35 / $2,207.73
| Professional | | $334.65 | $457.35 | $2,207.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $267.33 / $1,042.33 / $3,993.39
| Facility | | $267.33 | $1,042.33 | $3,993.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $374.14 / $478.38 / $2,226.08
| Professional | | $374.14 | $478.38 | $2,226.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $1,775.81 / $1,978.76
| Professional | | $32.34 | $1,775.81 | $1,978.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,303.53 / $13,737.97 / $17,393.36
| Facility | | $10,303.53 | $13,737.97 | $17,393.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $442.07 / $473.24 / $2,368.07
| Professional | | $442.07 | $473.24 | $2,368.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,800.00 / $26,422.00 / $29,092.00
| Facility | | $11,800.00 | $26,422.00 | $29,092.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,067.67 / $1,664.10 / $2,612.59
| Professional | | $1,067.67 | $1,664.10 | $2,612.59 |