- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,008.19 / $7,650.73 / $24,764.00
| Facility | | $2,008.19 | $7,650.73 | $24,764.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $443.72 / $443.72 / $1,004.10
| Facility | 52 | $443.72 | $443.72 | $1,004.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $710.66 / $897.88 / $2,008.19
| Professional | | $710.66 | $897.88 | $2,008.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,213.03 / $1,213.03 / $1,213.03
| Professional | | $1,213.03 | $1,213.03 | $1,213.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,280.65 / $7,089.79 / $14,346.13
| Facility | | $2,280.65 | $7,089.79 | $14,346.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $677.67 / $1,228.00 / $2,305.96
| Professional | | $677.67 | $1,228.00 | $2,305.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $715.00 / $3,208.42 / $4,122.88
| Facility | | $715.00 | $3,208.42 | $4,122.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $745.44 / $1,108.23 / $1,901.96
| Professional | | $745.44 | $1,108.23 | $1,901.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $742.62 / $1,046.33 / $1,664.00
| Facility | | $742.62 | $1,046.33 | $1,664.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,683.70 / $2,838.69 / $3,329.76
| Professional | | $1,683.70 | $2,838.69 | $3,329.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.48 / $673.66 / $1,110.38
| Professional | | $71.48 | $673.66 | $1,110.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $16,959.00 / $23,485.00
| Facility | | $2,912.00 | $16,959.00 | $23,485.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $717.88 / $990.67 / $1,920.63
| Professional | | $717.88 | $990.67 | $1,920.63 |