- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,454.02 / $7,365.00 / $14,285.00
| Facility | | $1,454.02 | $7,365.00 | $14,285.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $123.69 / $148.97 / $725.27
| Facility | 52 | $123.69 | $148.97 | $725.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $224.33 / $407.40 / $1,509.51
| Professional | | $224.33 | $407.40 | $1,509.51 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $123.69 / $624.12 / $754.76
| Professional | 52 | $123.69 | $624.12 | $754.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $224.33 / $287.92 / $351.97
| Professional | | $224.33 | $287.92 | $351.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,232.00 / $8,107.00 / $16,952.00
| Facility | | $2,232.00 | $8,107.00 | $16,952.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $217.40 / $873.62 / $1,872.84
| Professional | | $217.40 | $873.62 | $1,872.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,482.00 / $18,730.00 / $18,730.00
| Facility | | $14,482.00 | $18,730.00 | $18,730.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $259.25 / $573.38 / $2,410.41
| Professional | | $259.25 | $573.38 | $2,410.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $220.78 / $1,454.03 / $12,989.00
| Facility | | $220.78 | $1,454.03 | $12,989.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $848.95 / $848.95 / $848.95
| Facility | 52 | $848.95 | $848.95 | $848.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,334.59 / $2,470.50 / $8,740.16
| Professional | | $1,334.59 | $2,470.50 | $8,740.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,426.00 / $4,963.00 / $15,184.00
| Facility | | $2,426.00 | $4,963.00 | $15,184.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,334.59 / $1,799.53 / $3,766.18
| Professional | | $1,334.59 | $1,799.53 | $3,766.18 |