- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $559.41 / $2,312.40 / $4,112.97
| Facility | | $559.41 | $2,312.40 | $4,112.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.00 / $607.07 / $1,241.54
| Professional | | $197.00 | $607.07 | $1,241.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.19 / $169.41 / $393.07
| Professional | | $166.19 | $169.41 | $393.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,327.00 / $2,706.00 / $3,620.00
| Facility | | $1,327.00 | $2,706.00 | $3,620.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.07 / $616.49 / $1,807.57
| Professional | | $223.07 | $616.49 | $1,807.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $1,087.39 / $1,652.00
| Facility | | $375.00 | $1,087.39 | $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
- $240.38 / $599.60 / $1,751.13
| Professional | | $240.38 | $599.60 | $1,751.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,465.89 / $1,465.89
| Facility | | $55.00 | $1,465.89 | $1,465.89 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $727.83 / $782.61 / $782.61
| Facility | 52 | $727.83 | $782.61 | $782.61 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $181.96 / $195.65 / $195.65
| Facility | 53 | $181.96 | $195.65 | $195.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,976.58 / $6,044.48 / $6,714.23
| Professional | | $2,976.58 | $6,044.48 | $6,714.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $875.00 / $2,257.00 / $4,099.00
| Facility | | $875.00 | $2,257.00 | $4,099.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $818.16 / $1,243.32 / $2,032.86
| Professional | | $818.16 | $1,243.32 | $2,032.86 |