- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $7,623.54 / $9,970.24
| Facility | | $1,350.00 | $7,623.54 | $9,970.24 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $355.33 / $451.07 / $673.59
| Facility | 52 | $355.33 | $451.07 | $673.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $710.66 / $897.87 / $1,719.80
| Professional | | $710.66 | $897.87 | $1,719.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,072.26 / $1,416.92 / $2,003.37
| Professional | | $1,072.26 | $1,416.92 | $2,003.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $834.12 / $1,281.07 / $2,205.77
| Professional | | $834.12 | $1,281.07 | $2,205.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $710.66 / $1,266.52 / $1,886.54
| Facility | | $710.66 | $1,266.52 | $1,886.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,136.08 / $1,136.08 / $1,800.77
| Professional | | $1,136.08 | $1,136.08 | $1,800.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $1,339.90 / $1,805.00
| Professional | | $5.00 | $1,339.90 | $1,805.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,293.00 / $12,216.00 / $19,066.00
| Facility | | $5,293.00 | $12,216.00 | $19,066.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $759.69 / $1,157.46 / $2,007.17
| Professional | | $759.69 | $1,157.46 | $2,007.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,021.26 / $14,302.50 / $26,542.00
| Facility | | $4,021.26 | $14,302.50 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $1,330.90 / $10,845.40 / $10,845.40
| Facility | 52 | $1,330.90 | $10,845.40 | $10,845.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,301.36 / $5,301.36 / $6,050.10
| Professional | | $5,301.36 | $5,301.36 | $6,050.10 |