- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $2,344.23 / $8,511.38
| Facility | | $407.38 | $2,344.23 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $407.38 / $1,023.29
| Professional | | $181.97 | $407.38 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $109.65 / $181.97
| Professional | | $85.11 | $109.65 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $3,162.28 / $6,760.83
| Facility | | $1,819.70 | $3,162.28 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $616.60 / $912.01
| Professional | | $269.15 | $616.60 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $562.34 / $1,174.90
| Professional | | $263.03 | $562.34 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.98 / $524.81 / $1,698.24
| Facility | | $194.98 | $524.81 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $724.44 / $724.44 / $724.44
| Facility | 52 | $724.44 | $724.44 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $181.97 / $181.97 / $181.97
| Facility | 53 | $181.97 | $181.97 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $851.14 / $3,311.31
| Professional | | $177.83 | $851.14 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $812.83 / $1,174.90
| Professional | | $436.52 | $812.83 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $676.08 / $1,023.29
| Professional | | $346.74 | $676.08 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $2,951.21 / $3,467.37
| Facility | | $2,951.21 | $2,951.21 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.98 / $691.83 / $1,230.27
| Professional | | $3.98 | $691.83 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $3,162.28 / $8,128.31
| Facility | | $1,479.11 | $3,162.28 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $512.86 / $1,023.29
| Professional | | $263.03 | $512.86 | $1,023.29 |