- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.08 / $2,036.00 / $4,069.00
| Facility | | $400.08 | $2,036.00 | $4,069.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $90.93 / $274.58 / $716.66
| Facility | 52 | $90.93 | $274.58 | $716.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.95 / $357.07 / $1,074.01
| Professional | | $194.95 | $357.07 | $1,074.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.94 / $268.58 / $369.94
| Professional | | $162.94 | $268.58 | $369.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,319.00 / $2,687.00 / $3,637.00
| Facility | | $1,319.00 | $2,687.00 | $3,637.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.16 / $497.34 / $1,226.06
| Professional | | $212.16 | $497.34 | $1,226.06 |
- 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
- $269.18 / $269.18 / $269.18
| Facility | 52 | $269.18 | $269.18 | $269.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $233.31 / $463.01 / $1,137.25
| Professional | | $233.31 | $463.01 | $1,137.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,351.50 / $1,384.26 / $16,394.00
| Facility | | $1,351.50 | $1,384.26 | $16,394.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $718.14 / $777.78 / $777.78
| Facility | 52 | $718.14 | $777.78 | $777.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,271.42 / $4,354.72 / $5,096.78
| Professional | | $2,271.42 | $4,354.72 | $5,096.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,049.00 / $2,216.00 / $4,099.00
| Facility | | $1,049.00 | $2,216.00 | $4,099.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $322.97 / $654.27 / $1,413.75
| Professional | | $322.97 | $654.27 | $1,413.75 |