- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $153.33 / $406.55 / $3,465.00
| Facility | | $153.33 | $406.55 | $3,465.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $76.67 / $203.28 / $203.28
| Facility | 52 | $76.67 | $203.28 | $203.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.33 / $276.27 / $1,485.80
| Professional | | $153.33 | $276.27 | $1,485.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $779.06 / $1,577.10 / $3,351.32
| Facility | | $779.06 | $1,577.10 | $3,351.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $322.85 / $638.66 / $1,408.73
| Professional | | $322.85 | $638.66 | $1,408.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $945.91 / $1,476.32 / $3,551.49
| Facility | | $945.91 | $1,476.32 | $3,551.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.80 / $699.21 / $1,739.34
| Professional | | $338.80 | $699.21 | $1,739.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $759.15 / $1,301.63 / $2,796.45
| Facility | | $759.15 | $1,301.63 | $2,796.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $342.65 / $686.48 / $1,510.76
| Professional | | $342.65 | $686.48 | $1,510.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $220.88 / $486.24 / $1,342.66
| Facility | | $220.88 | $486.24 | $1,342.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $357.61 / $818.64 / $2,312.13
| Professional | | $357.61 | $818.64 | $2,312.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,224.00 / $3,500.00 / $6,361.00
| Facility | | $1,224.00 | $3,500.00 | $6,361.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $387.45 / $781.36 / $1,542.11
| Professional | | $387.45 | $781.36 | $1,542.11 |