- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,551.00 / $5,503.00 / $10,651.00
| Facility | | $2,551.00 | $5,503.00 | $10,651.00 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $401.76 / $401.76 / $401.76
| Facility | 53 | $401.76 | $401.76 | $401.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,347.71 / $6,547.00 / $13,131.00
| Facility | | $2,347.71 | $6,547.00 | $13,131.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,008.82 / $2,291.89 / $3,374.82
| Facility | | $2,008.82 | $2,291.89 | $3,374.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,838.58 / $2,621.68 / $3,370.73
| Professional | | $1,838.58 | $2,621.68 | $3,370.73 |
- Facility/Professional
- Professional
- Modifier
- 53
- Low / Median / High Price
- $2,860.02 / $2,860.02 / $2,860.02
| Professional | 53 | $2,860.02 | $2,860.02 | $2,860.02 |
- Facility/Professional
- Professional
- Modifier
- 80
- Low / Median / High Price
- $54.48 / $54.48 / $54.48
| Professional | 80 | $54.48 | $54.48 | $54.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,292.00 / $8,535.00 / $12,740.00
| Facility | | $1,292.00 | $8,535.00 | $12,740.00 |