- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $1,445.44 / $5,623.41
| Facility | | $302.00 | $1,445.44 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $79.43 / $151.36 / $269.15
| Facility | 53 | $79.43 | $151.36 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $1,348.96 / $2,630.27
| Facility | | $724.44 | $1,348.96 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $831.76 / $1,000.00
| Facility | | $302.00 | $831.76 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $489.78 / $1,348.96
| Professional | | $208.93 | $489.78 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $2,187.76 / $4,570.88
| Facility | | $758.58 | $2,187.76 | $4,570.88 |