- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $829.42 / $3,133.00 / $7,416.00
| Facility | | $829.42 | $3,133.00 | $7,416.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.80 / $732.63 / $1,275.32
| Professional | | $197.80 | $732.63 | $1,275.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,434.00 / $5,082.00 / $9,729.00
| Facility | | $3,434.00 | $5,082.00 | $9,729.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $242.79 / $853.00 / $1,642.11
| Professional | | $242.79 | $853.00 | $1,642.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $343.38 / $600.00 / $1,652.00
| Facility | | $343.38 | $600.00 | $1,652.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $274.70 / $274.70 / $274.70
| Facility | 52 | $274.70 | $274.70 | $274.70 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $68.68 / $68.68 / $68.68
| Facility | 53 | $68.68 | $68.68 | $68.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $256.64 / $474.99 / $1,632.71
| Professional | | $256.64 | $474.99 | $1,632.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $211.88 / $729.76 / $1,522.36
| Facility | | $211.88 | $729.76 | $1,522.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.68 / $733.90 / $1,402.25
| Professional | | $254.68 | $733.90 | $1,402.25 |
- Facility/Professional
- Professional
- Modifier
- 53
- Low / Median / High Price
- $329.13 / $329.13 / $1,352.84
| Professional | 53 | $329.13 | $329.13 | $1,352.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,463.00 / $4,182.00 / $7,016.00
| Facility | | $1,463.00 | $4,182.00 | $7,016.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,066.00 / $1,482.00 / $2,308.19
| Professional | | $1,066.00 | $1,482.00 | $2,308.19 |