- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.16 / $3,259.25 / $12,765.09
| Facility | | $467.16 | $3,259.25 | $12,765.09 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $38.75 / $38.75 / $179.68
| Facility | 52 | $38.75 | $38.75 | $179.68 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $15.50 / $15.50 / $71.87
| Facility | 53 | $15.50 | $15.50 | $71.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.50 / $359.36 / $1,770.00
| Professional | | $77.50 | $359.36 | $1,770.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,724.93 / $4,899.30 / $9,476.84
| Facility | | $3,724.93 | $4,899.30 | $9,476.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.62 / $183.22 / $709.53
| Professional | | $80.62 | $183.22 | $709.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $179.03 / $423.11 / $1,131.96
| Professional | | $179.03 | $423.11 | $1,131.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $98.81 / $539.04 / $3,044.00
| Facility | | $98.81 | $539.04 | $3,044.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $297.91 / $297.91 / $297.91
| Facility | 52 | $297.91 | $297.91 | $297.91 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $74.48 / $74.48 / $74.48
| Facility | 53 | $74.48 | $74.48 | $74.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $486.95 / $810.88 / $1,338.29
| Professional | | $486.95 | $810.88 | $1,338.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.35 / $868.63 / $1,236.80
| Facility | | $199.35 | $868.63 | $1,236.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $179.03 / $698.98 / $1,107.42
| Professional | | $179.03 | $698.98 | $1,107.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,044.00 / $3,726.00 / $7,934.00
| Facility | | $3,044.00 | $3,726.00 | $7,934.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $486.95 / $863.90 / $1,056.56
| Professional | | $486.95 | $863.90 | $1,056.56 |