- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79.43 / $257.04 / $3,801.89
| Facility | | $79.43 | $257.04 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $194.98 / $457.09
| Professional | | $85.11 | $194.98 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,862.09 / $4,265.80
| Facility | | $1,202.26 | $1,862.09 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $346.74 / $870.96
| Professional | | $158.49 | $346.74 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $1,000.00 / $2,398.83
| Facility | | $616.60 | $1,000.00 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $117.49 / $117.49 / $117.49
| Facility | 52 | $117.49 | $117.49 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $29.51 / $29.51 / $29.51
| Facility | 53 | $29.51 | $29.51 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $371.54 / $1,023.29
| Professional | | $173.78 | $371.54 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $954.99 / $1,862.09
| Facility | | $758.58 | $954.99 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $389.05 / $912.01
| Professional | | $186.21 | $389.05 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $263.03 / $758.58
| Facility | | $100.00 | $263.03 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $1,949.84 / $1,949.84 / $1,949.84
| Facility | 52 | $1,949.84 | $1,949.84 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $489.78 / $1,949.84
| Professional | | $239.88 | $489.78 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $2,691.53 / $6,456.54
| Facility | | $1,445.44 | $2,691.53 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $263.03 / $724.44
| Professional | | $100.00 | $263.03 | $724.44 |