- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,924.00 / $2,984.14 / $10,526.65
| Facility | | $1,924.00 | $2,984.14 | $10,526.65 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $434.54 / $434.54 / $1,020.36
| Facility | 52 | $434.54 | $434.54 | $1,020.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $855.07 / $1,161.86 / $2,554.40
| Professional | | $855.07 | $1,161.86 | $2,554.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,593.78 / $5,097.00 / $16,742.00
| Facility | | $1,593.78 | $5,097.00 | $16,742.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $1,495.28 / $1,495.28 / $10,845.40
| Facility | 52 | $1,495.28 | $1,495.28 | $10,845.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $720.59 / $1,429.89 / $5,301.36
| Professional | | $720.59 | $1,429.89 | $5,301.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $573.82 / $573.82 / $573.82
| Professional | | $573.82 | $573.82 | $573.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $886.24 / $1,499.25 / $2,665.29
| Professional | | $886.24 | $1,499.25 | $2,665.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $717.87 / $1,529.66 / $6,679.00
| Facility | | $717.87 | $1,529.66 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $442.42 / $845.14 / $1,328.06
| Professional | | $442.42 | $845.14 | $1,328.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $895.39 / $1,785.77 / $2,695.21
| Professional | | $895.39 | $1,785.77 | $2,695.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,066.72 / $4,556.76 / $10,797.96
| Facility | | $3,066.72 | $4,556.76 | $10,797.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,101.33 / $1,282.36 / $1,737.77
| Professional | | $1,101.33 | $1,282.36 | $1,737.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,324.00 / $6,280.00 / $26,542.00
| Facility | | $2,324.00 | $6,280.00 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $1,495.28 / $1,495.28 / $10,845.40
| Facility | 52 | $1,495.28 | $1,495.28 | $10,845.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $820.61 / $1,477.39 / $5,301.36
| Professional | | $820.61 | $1,477.39 | $5,301.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,324.00 / $5,097.00 / $10,764.00
| Facility | | $2,324.00 | $5,097.00 | $10,764.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $820.61 / $1,239.08 / $2,643.51
| Professional | | $820.61 | $1,239.08 | $2,643.51 |