- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $518.86 / $933.27 / $5,330.32
| Facility | | $518.86 | $933.27 | $5,330.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $289.72 / $466.21 / $679.23
| Professional | | $289.72 | $466.21 | $679.23 |
- Facility/Professional
- Professional
- Modifier
- 53
- Low / Median / High Price
- $61.66 / $88.10 / $113.14
| Professional | 53 | $61.66 | $88.10 | $113.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,046.22 / $2,046.22 / $2,046.22
| Facility | | $2,046.22 | $2,046.22 | $2,046.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $304.04 / $371.62 / $710.84
| Professional | | $304.04 | $371.62 | $710.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.66 / $426.66 / $611.00
| Facility | | $426.66 | $426.66 | $611.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $341.33 / $341.33 / $341.33
| Facility | 52 | $341.33 | $341.33 | $341.33 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $85.33 / $85.33 / $85.33
| Facility | 53 | $85.33 | $85.33 | $85.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $317.24 / $541.61 / $970.19
| Professional | | $317.24 | $541.61 | $970.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,375.30 / $5,375.30 / $6,302.50
| Facility | | $5,375.30 | $5,375.30 | $6,302.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $291.50 / $405.68 / $509.01
| Professional | | $291.50 | $405.68 | $509.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.56 / $549.44 / $959.23
| Professional | | $309.56 | $549.44 | $959.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $344.81 / $2,904.67 / $5,708.14
| Facility | | $344.81 | $2,904.67 | $5,708.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $308.27 / $483.16 / $625.05
| Professional | | $308.27 | $483.16 | $625.05 |
- Facility/Professional
- Professional
- Modifier
- 53
- Low / Median / High Price
- $61.66 / $106.69 / $135.85
| Professional | 53 | $61.66 | $106.69 | $135.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $451.44 / $676.18 / $917.35
| Professional | | $451.44 | $676.18 | $917.35 |