- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $2,137.96 / $3,890.45
| Facility | | $323.59 | $2,137.96 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $245.47 / $794.33
| Professional | | $112.20 | $245.47 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $3,467.37 / $3,801.89
| Facility | | $1,380.38 | $3,467.37 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $436.52 / $954.99
| Professional | | $218.78 | $436.52 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $1,096.48 / $2,570.40
| Facility | | $660.69 | $1,096.48 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $245.47 / $245.47 / $245.47
| Facility | 22 | $245.47 | $245.47 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $165.96 / $165.96 / $165.96
| Facility | 52 | $165.96 | $165.96 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $41.69 / $41.69 / $41.69
| Facility | 53 | $41.69 | $41.69 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $501.19 / $1,174.90
| Professional | | $229.09 | $501.19 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $1,047.13 / $2,041.74
| Facility | | $831.76 | $1,047.13 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $478.63 / $1,000.00
| Professional | | $263.03 | $478.63 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.18 / $575.44 / $2,570.40
| Facility | | $162.18 | $575.44 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $467.74 / $1,348.96
| Professional | | $234.42 | $467.74 | $1,348.96 |
- 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
- $141.25 / $331.13 / $831.76
| Professional | | $141.25 | $331.13 | $831.76 |