- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $359.60 / $2,006.00 / $5,638.75
| Facility | | $359.60 | $2,006.00 | $5,638.75 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $79.55 / $240.22 / $660.19
| Facility | 52 | $79.55 | $240.22 | $660.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.54 / $312.39 / $964.54
| Professional | | $162.54 | $312.39 | $964.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.66 / $235.32 / $321.70
| Professional | | $117.66 | $235.32 | $321.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,319.00 / $2,676.00 / $3,620.00
| Facility | | $1,319.00 | $2,676.00 | $3,620.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.92 / $406.53 / $1,046.78
| Professional | | $183.92 | $406.53 | $1,046.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $455.00 / $1,087.39 / $1,992.00
| Facility | | $455.00 | $1,087.39 | $1,992.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $237.66 / $237.66 / $237.66
| Facility | 52 | $237.66 | $237.66 | $237.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.08 / $388.99 / $1,011.95
| Professional | | $196.08 | $388.99 | $1,011.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,188.72 / $1,213.14 / $16,394.00
| Facility | | $1,188.72 | $1,213.14 | $16,394.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $634.61 / $682.37 / $682.37
| Facility | 52 | $634.61 | $682.37 | $682.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,166.58 / $4,122.24 / $4,857.08
| Professional | | $2,166.58 | $4,122.24 | $4,857.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $830.00 / $2,257.00 / $4,099.00
| Facility | | $830.00 | $2,257.00 | $4,099.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.39 / $582.19 / $1,197.33
| Professional | | $210.39 | $582.19 | $1,197.33 |