- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $155.43 / $2,168.00 / $6,441.91
| Facility | | $155.43 | $2,168.00 | $6,441.91 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $31.09 / $189.67 / $189.67
| Facility | 53 | $31.09 | $189.67 | $189.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.71 / $251.82 / $2,131.80
| Professional | | $148.71 | $251.82 | $2,131.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $624.54 / $2,656.15 / $5,761.70
| Facility | | $624.54 | $2,656.15 | $5,761.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $277.27 / $892.00 / $2,865.25
| Professional | | $277.27 | $892.00 | $2,865.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,147.77 / $3,045.81 / $7,327.11
| Facility | | $2,147.77 | $3,045.81 | $7,327.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $355.22 / $1,011.58 / $3,570.95
| Professional | | $355.22 | $1,011.58 | $3,570.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,745.99 / $2,784.60 / $5,769.38
| Facility | | $1,745.99 | $2,784.60 | $5,769.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.37 / $1,155.61 / $3,102.50
| Professional | | $311.37 | $1,155.61 | $3,102.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.82 / $1,484.98 / $3,906.64
| Facility | | $251.82 | $1,484.98 | $3,906.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,123.83 / $2,418.69 / $5,457.43
| Professional | | $1,123.83 | $2,418.69 | $5,457.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,296.00 / $3,500.00 / $6,361.00
| Facility | | $2,296.00 | $3,500.00 | $6,361.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.67 / $2,459.69 / $4,305.50
| Professional | | $1,122.67 | $2,459.69 | $4,305.50 |