- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,017.39 / $4,518.60 / $13,841.56
| Facility | | $1,017.39 | $4,518.60 | $13,841.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.73 / $597.14 / $1,406.81
| Professional | | $186.73 | $597.14 | $1,406.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.94 / $229.94 / $439.78
| Professional | | $229.94 | $229.94 | $439.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,533.80 / $2,223.57 / $3,902.23
| Facility | | $1,533.80 | $2,223.57 | $3,902.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.38 / $444.06 / $1,542.22
| Professional | | $195.38 | $444.06 | $1,542.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.56 / $1,215.30 / $2,689.42
| Professional | | $323.56 | $1,215.30 | $2,689.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $195.91 / $782.61 / $2,219.96
| Facility | | $195.91 | $782.61 | $2,219.96 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $727.83 / $727.83 / $727.83
| Facility | 52 | $727.83 | $727.83 | $727.83 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $181.96 / $181.96 / $181.96
| Facility | 53 | $181.96 | $181.96 | $181.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.10 / $2,021.48 / $6,044.48
| Professional | | $1,318.10 | $2,021.48 | $6,044.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $486.86 / $1,519.25 / $2,685.29
| Facility | | $486.86 | $1,519.25 | $2,685.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $437.40 / $1,736.99 / $2,444.61
| Professional | | $437.40 | $1,736.99 | $2,444.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.00 / $1,536.90 / $3,046.30
| Professional | | $4.00 | $1,536.90 | $3,046.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,044.00 / $3,726.00 / $7,934.00
| Facility | | $3,044.00 | $3,726.00 | $7,934.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.10 / $2,021.48 / $2,460.44
| Professional | | $1,318.10 | $2,021.48 | $2,460.44 |