- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $101.21 / $1,144.00 / $7,036.00
| Facility | | $101.21 | $1,144.00 | $7,036.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $12.54 / $12.54 / $32.20
| Facility | 52 | $12.54 | $12.54 | $32.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.08 / $64.40 / $102.27
| Professional | | $25.08 | $64.40 | $102.27 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $12.54 / $32.20 / $42.86
| Professional | 52 | $12.54 | $32.20 | $42.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,974.00 / $2,971.00 / $7,022.00
| Facility | | $1,974.00 | $2,971.00 | $7,022.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.09 / $68.05 / $115.93
| Professional | | $30.09 | $68.05 | $115.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.53 / $76.79 / $115.29
| Professional | | $35.53 | $76.79 | $115.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.34 / $62.23 / $116.33
| Facility | | $29.34 | $62.23 | $116.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.58 / $65.02 / $106.18
| Professional | | $31.58 | $65.02 | $106.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $730.00 / $1,464.00 / $3,011.00
| Facility | | $730.00 | $1,464.00 | $3,011.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.56 / $106.76 / $157.00
| Professional | | $76.56 | $106.76 | $157.00 |