- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $724.44 / $6,309.57
| Facility | | $208.93 | $724.44 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $630.96 / $1,348.96
| Professional | | $218.78 | $630.96 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $3,801.89 / $8,709.64
| Facility | | $1,348.96 | $3,801.89 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $933.25 / $2,344.23
| Professional | | $398.11 | $933.25 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,754.23 / $6,606.93
| Facility | | $1,698.24 | $2,754.23 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $302.00 / $302.00 / $302.00
| Facility | 52 | $302.00 | $302.00 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $1,000.00 / $3,019.95
| Professional | | $426.58 | $1,000.00 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,630.27 / $5,128.61
| Facility | | $2,137.96 | $2,630.27 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $1,202.26 / $2,570.40
| Professional | | $478.63 | $1,202.26 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $724.44 / $2,089.30
| Facility | | $239.88 | $724.44 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $1,348.96 / $5,248.07
| Professional | | $707.95 | $1,348.96 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $3,467.37 / $6,760.83
| Facility | | $1,230.27 | $3,467.37 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $741.31 / $2,089.30
| Professional | | $257.04 | $741.31 | $2,089.30 |