- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $6,606.93 / $9,772.37
| Facility | | $812.83 | $6,606.93 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $457.09 / $2,398.83
| Professional | | $239.88 | $457.09 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- 53
- Low / Median / High Price
- $77.62 / $77.62 / $77.62
| Professional | 53 | $77.62 | $77.62 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $3,715.35 / $8,128.31
| Facility | | $1,778.28 | $3,715.35 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $1,995.26 / $2,454.71
| Professional | | $416.87 | $1,995.26 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $478.63 / $2,454.71
| Professional | | $275.42 | $478.63 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $2,398.83 / $8,912.51
| Facility | | $338.84 | $2,398.83 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $478.63 / $2,511.89
| Professional | | $263.03 | $478.63 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- 53
- Low / Median / High Price
- $77.62 / $77.62 / $77.62
| Professional | 53 | $77.62 | $77.62 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $7,079.46 / $9,772.37
| Facility | | $5,128.61 | $7,079.46 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $446.68 / $2,238.72
| Professional | | $316.23 | $446.68 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $1,174.90 / $7,413.10
| Professional | | $446.68 | $1,174.90 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $12,302.69 / $12,302.69
| Facility | | $5,495.41 | $12,302.69 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $478.63 / $2,089.30
| Professional | | $263.03 | $478.63 | $2,089.30 |