- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,715.35 / $6,760.83
| Facility | | $1,698.24 | $3,715.35 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $741.31 / $2,137.96
| Professional | | $194.98 | $741.31 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $204.17 / $302.00
| Professional | | $158.49 | $204.17 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $1,445.44 / $2,691.53
| Facility | | $549.54 | $1,445.44 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $707.95 / $1,445.44
| Professional | | $234.42 | $707.95 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $977.24 / $1,584.89
| Facility | | $891.25 | $977.24 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $512.86 / $1,548.82
| Professional | | $213.80 | $512.86 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $758.58 / $1,949.84
| Facility | | $204.17 | $758.58 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $724.44 / $724.44 / $3,715.35
| Facility | 52 | $724.44 | $724.44 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $181.97 / $181.97 / $933.25
| Facility | 53 | $181.97 | $181.97 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,348.96 / $6,025.60
| Professional | | $870.96 | $1,348.96 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $1,862.09 / $4,677.35
| Facility | | $977.24 | $1,862.09 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $707.95 / $1,445.44
| Professional | | $204.17 | $707.95 | $1,445.44 |