- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $5,248.07 / $10,964.78
| Facility | | $1,148.15 | $5,248.07 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $2,951.21 / $2,951.21 / $7,079.46
| Facility | 53 | $2,951.21 | $2,951.21 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $851.14 / $2,818.38
| Professional | | $323.59 | $851.14 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $5,888.44 / $13,803.84
| Facility | | $2,137.96 | $5,888.44 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $1,047.13 / $2,454.71
| Professional | | $363.08 | $1,047.13 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $2,884.03 / $12,302.69
| Facility | | $562.34 | $2,884.03 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $112.20 / $112.20 / $112.20
| Facility | 53 | $112.20 | $112.20 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $56.23 / $56.23 / $56.23
| Facility | AS | $56.23 | $56.23 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $1,000.00 / $2,570.40
| Professional | | $389.05 | $1,000.00 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $5,623.41 / $13,182.57
| Facility | | $1,995.26 | $5,623.41 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $977.24 / $2,137.96
| Professional | | $346.74 | $977.24 | $2,137.96 |