- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,218.18 / $4,226.50 / $13,200.00
| Facility | | $1,218.18 | $4,226.50 | $13,200.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $408.32 / $408.32 / $408.32
| Facility | 52 | $408.32 | $408.32 | $408.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $816.62 / $816.63 / $1,218.18
| Professional | | $816.62 | $816.63 | $1,218.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,362.46 / $11,614.37 / $18,480.11
| Facility | | $7,362.46 | $11,614.37 | $18,480.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $704.20 / $946.85 / $1,257.90
| Professional | | $704.20 | $946.85 | $1,257.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $779.99 / $981.72 / $1,326.08
| Professional | | $779.99 | $981.72 | $1,326.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $830.59 / $1,481.00 / $9,412.67
| Facility | | $830.59 | $1,481.00 | $9,412.67 |
- 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
- $683.72 / $987.60 / $5,421.36
| Professional | | $683.72 | $987.60 | $5,421.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,280.00 / $5,524.00 / $9,232.95
| Facility | | $1,280.00 | $5,524.00 | $9,232.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.74 / $845.28 / $1,312.35
| Professional | | $645.74 | $845.28 | $1,312.35 |