- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,389.00 / $2,897.00 / $6,483.00
| Facility | | $1,389.00 | $2,897.00 | $6,483.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.59 / $732.63 / $1,413.64
| Professional | | $193.59 | $732.63 | $1,413.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $191.08 / $191.08 / $191.08
| Professional | | $191.08 | $191.08 | $191.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $552.79 / $2,064.02 / $3,616.69
| Facility | | $552.79 | $2,064.02 | $3,616.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $233.94 / $641.82 / $1,015.25
| Professional | | $233.94 | $641.82 | $1,015.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $734.77 / $971.62 / $1,591.99
| Facility | | $734.77 | $971.62 | $1,591.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.60 / $525.00 / $1,632.34
| Professional | | $213.60 | $525.00 | $1,632.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $202.02 / $755.29 / $1,696.37
| Facility | | $202.02 | $755.29 | $1,696.37 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $727.83 / $727.83 / $3,716.72
| Facility | 52 | $727.83 | $727.83 | $3,716.72 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $181.96 / $181.96 / $929.18
| Facility | 53 | $181.96 | $181.96 | $929.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $906.10 / $1,279.21 / $6,044.48
| Professional | | $906.10 | $1,279.21 | $6,044.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $966.00 / $2,517.00 / $4,486.00
| Facility | | $966.00 | $2,517.00 | $4,486.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $879.45 / $1,088.00 / $1,836.07
| Professional | | $879.45 | $1,088.00 | $1,836.07 |