- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $984.00 / $4,173.00 / $7,605.00
| Facility | | $984.00 | $4,173.00 | $7,605.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $237.39 / $395.22 / $1,876.35
| Professional | | $237.39 | $395.22 | $1,876.35 |
- Facility/Professional
- Professional
- Modifier
- 53
- Low / Median / High Price
- $40.38 / $216.68 / $439.17
| Professional | 53 | $40.38 | $216.68 | $439.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.52 / $219.47 / $1,648.63
| Professional | | $197.52 | $219.47 | $1,648.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $688.17 / $2,484.53 / $4,140.09
| Facility | | $688.17 | $2,484.53 | $4,140.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $262.85 / $978.96 / $1,601.93
| Professional | | $262.85 | $978.96 | $1,601.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,084.43 / $3,084.43 / $3,084.43
| Facility | | $3,084.43 | $3,084.43 | $3,084.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.81 / $399.16 / $2,075.07
| Professional | | $243.81 | $399.16 | $2,075.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $222.10 / $920.87 / $3,612.00
| Facility | | $222.10 | $920.87 | $3,612.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $840.46 / $840.46 / $840.46
| Facility | 52 | $840.46 | $840.46 | $840.46 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $210.11 / $210.11 / $210.11
| Facility | 53 | $210.11 | $210.11 | $210.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.60 / $1,505.17 / $9,714.64
| Professional | | $309.60 | $1,505.17 | $9,714.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,343.00 / $3,339.00 / $5,838.00
| Facility | | $2,343.00 | $3,339.00 | $5,838.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $301.00 / $1,307.13 / $2,621.41
| Professional | | $301.00 | $1,307.13 | $2,621.41 |