- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $207.08 / $724.58 / $4,557.00
| Facility | | $207.08 | $724.58 | $4,557.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $103.54 / $362.29 / $362.29
| Facility | 52 | $103.54 | $362.29 | $362.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.08 / $616.70 / $1,231.11
| Professional | | $207.08 | $616.70 | $1,231.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,053.17 / $3,244.31 / $6,762.24
| Facility | | $1,053.17 | $3,244.31 | $6,762.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $437.77 / $1,045.83 / $2,477.21
| Professional | | $437.77 | $1,045.83 | $2,477.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,557.34 / $2,612.23 / $6,284.07
| Facility | | $1,557.34 | $2,612.23 | $6,284.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $466.58 / $1,065.80 / $3,043.85
| Professional | | $466.58 | $1,065.80 | $3,043.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,343.26 / $2,303.13 / $4,948.09
| Facility | | $1,343.26 | $2,303.13 | $4,948.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $461.96 / $1,111.25 / $2,643.83
| Professional | | $461.96 | $1,111.25 | $2,643.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $277.20 / $724.58 / $2,105.25
| Facility | | $277.20 | $724.58 | $2,105.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $807.86 / $1,754.64 / $5,293.24
| Professional | | $807.86 | $1,754.64 | $5,293.24 |
- 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
- $734.42 / $1,440.20 / $2,834.86
| Professional | | $734.42 | $1,440.20 | $2,834.86 |