- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,241.22 / $11,611.47 / $24,068.03
| Facility | | $4,241.22 | $11,611.47 | $24,068.03 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $107.57 / $107.57 / $561.45
| Facility | 52 | $107.57 | $107.57 | $561.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.14 / $501.47 / $1,908.72
| Professional | | $215.14 | $501.47 | $1,908.72 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $107.57 / $561.45 / $624.12
| Professional | 52 | $107.57 | $561.45 | $624.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $428.12 / $428.12 / $428.12
| Professional | | $428.12 | $428.12 | $428.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,165.50 / $10,739.86 / $20,774.36
| Facility | | $8,165.50 | $10,739.86 | $20,774.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.75 / $513.09 / $2,228.11
| Professional | | $225.75 | $513.09 | $2,228.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $510.19 / $2,194.94 / $3,635.26
| Professional | | $510.19 | $2,194.94 | $3,635.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $274.30 / $1,684.34 / $9,496.00
| Facility | | $274.30 | $1,684.34 | $9,496.00 |
- 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
- $1,578.73 / $2,477.35 / $4,438.35
| Professional | | $1,578.73 | $2,477.35 | $4,438.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $559.71 / $2,605.82 / $4,925.84
| Facility | | $559.71 | $2,605.82 | $4,925.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $510.19 / $2,194.94 / $3,261.89
| Professional | | $510.19 | $2,194.94 | $3,261.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,777.00 / $8,220.00 / $9,696.00
| Facility | | $6,777.00 | $8,220.00 | $9,696.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,821.62 / $2,755.57 / $3,008.09
| Professional | | $1,821.62 | $2,755.57 | $3,008.09 |