- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $8,511.38 / $20,417.38
| Facility | | $1,778.28 | $8,511.38 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $891.25 / $1,862.09
| Professional | | $537.03 | $891.25 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $691.83 / $954.99
| Professional | | $549.54 | $691.83 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $14,791.08 / $20,892.96
| Facility | | $8,912.51 | $14,791.08 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $707.95 / $1,174.90
| Professional | | $562.34 | $707.95 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $524.81 / $812.83
| Professional | | $446.68 | $524.81 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $16,982.44 / $27,542.29
| Facility | | $3,715.35 | $16,982.44 | $27,542.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $912.01 / $1,318.26
| Professional | | $588.84 | $912.01 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $3,019.95 / $32,359.37
| Facility | | $602.56 | $3,019.95 | $32,359.37 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $1,023.29 / $30,199.52 / $30,199.52
| Facility | 52 | $1,023.29 | $30,199.52 | $30,199.52 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $257.04 / $7,585.78 / $7,585.78
| Facility | 53 | $257.04 | $7,585.78 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $1,000.00 / $3,548.13
| Professional | | $562.34 | $1,000.00 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,801.89 / $25,703.96
| Facility | | $2,884.03 | $3,801.89 | $25,703.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $933.25 / $1,412.54
| Professional | | $562.34 | $933.25 | $1,412.54 |