- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $831.76 / $2,884.03
| Facility | | $186.21 | $831.76 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $724.44 / $1,698.24
| Professional | | $194.98 | $724.44 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $4,073.80 / $8,709.64
| Facility | | $2,511.89 | $4,073.80 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $977.24 / $2,691.53
| Professional | | $363.08 | $977.24 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $3,090.30 / $7,413.10
| Facility | | $1,949.84 | $3,090.30 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $275.42 / $275.42 / $275.42
| Facility | 52 | $275.42 | $275.42 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $69.18 / $69.18 / $69.18
| Facility | 53 | $69.18 | $69.18 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $1,000.00 / $3,388.44
| Professional | | $389.05 | $1,000.00 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $2,951.21 / $5,888.44
| Facility | | $2,398.83 | $2,951.21 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $1,202.26 / $2,884.03
| Professional | | $436.52 | $1,202.26 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $831.76 / $2,398.83
| Facility | | $223.87 | $831.76 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,862.09 / $6,025.60
| Professional | | $954.99 | $1,862.09 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $3,467.37 / $6,456.54
| Facility | | $1,445.44 | $3,467.37 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $851.14 / $2,570.40
| Professional | | $234.42 | $851.14 | $2,570.40 |