- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,981.07 / $7,016.18 / $19,148.84
| Facility | | $2,981.07 | $7,016.18 | $19,148.84 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $334.35 / $334.35 / $334.35
| Facility | 52 | $334.35 | $334.35 | $334.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $652.21 / $1,535.57 / $3,308.00
| Professional | | $652.21 | $1,535.57 | $3,308.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,646.56 / $11,718.32 / $21,998.27
| Facility | | $8,646.56 | $11,718.32 | $21,998.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $648.40 / $1,105.24 / $1,473.65
| Professional | | $648.40 | $1,105.24 | $1,473.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,351.20 / $1,679.16 / $2,233.39
| Professional | | $1,351.20 | $1,679.16 | $2,233.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $852.59 / $1,808.04 / $8,632.00
| Facility | | $852.59 | $1,808.04 | $8,632.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $10,845.40 / $10,845.40 / $10,845.40
| Facility | 52 | $10,845.40 | $10,845.40 | $10,845.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $944.41 / $1,716.02 / $5,421.36
| Professional | | $944.41 | $1,716.02 | $5,421.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,351.20 / $1,718.02 / $4,791.04
| Facility | | $1,351.20 | $1,718.02 | $4,791.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,305.00 / $1,681.64 / $2,220.19
| Professional | | $1,305.00 | $1,681.64 | $2,220.19 |
- 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
- $6,178.00 / $7,441.00 / $8,816.00
| Facility | | $6,178.00 | $7,441.00 | $8,816.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $944.41 / $1,630.67 / $1,776.13
| Professional | | $944.41 | $1,630.67 | $1,776.13 |