- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $6,918.31 / $13,489.63
| Facility | | $1,949.84 | $6,918.31 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $954.99 / $2,089.30
| Professional | | $676.08 | $954.99 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $707.95 / $1,288.25
| Professional | | $512.86 | $707.95 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $12,589.25 / $53,703.18
| Facility | | $2,454.71 | $12,589.25 | $53,703.18 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $1,479.11 / $1,479.11 / $1,479.11
| Facility | 22 | $1,479.11 | $1,479.11 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $1,000.00
| Facility | 52 | $1,000.00 | $1,000.00 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $1,047.13 / $1,862.09
| Professional | | $645.65 | $1,047.13 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $12,022.64 / $22,908.68
| Facility | | $6,165.95 | $12,022.64 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $407.38 / $870.96
| Professional | | $380.19 | $407.38 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $912.01
| Professional | | $32.36 | $33.11 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $10,232.93 / $15,848.93
| Facility | | $3,311.31 | $10,232.93 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $912.01 / $1,621.81
| Professional | | $616.60 | $912.01 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $562.34 / $562.34
| Professional | | $537.03 | $562.34 | $562.34 |