- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $388.19 / $1,416.00 / $3,519.45
| Facility | | $388.19 | $1,416.00 | $3,519.45 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $106.42 / $122.51 / $785.66
| Facility | 52 | $106.42 | $122.51 | $785.66 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $42.57 / $49.00 / $314.26
| Facility | 53 | $42.57 | $49.00 | $314.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.56 / $245.01 / $1,571.31
| Professional | | $155.56 | $245.01 | $1,571.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.21 / $167.50 / $793.94
| Professional | | $95.21 | $167.50 | $793.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,081.25 / $1,939.93 / $3,525.79
| Facility | | $1,081.25 | $1,939.93 | $3,525.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $201.93 / $336.40 / $1,739.04
| Professional | | $201.93 | $336.40 | $1,739.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $133.96 / $1,438.71 / $1,438.71
| Facility | | $133.96 | $1,438.71 | $1,438.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.77 / $650.00 / $1,197.32
| Facility | | $257.77 | $650.00 | $1,197.32 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $206.22 / $206.22 / $206.22
| Facility | 52 | $206.22 | $206.22 | $206.22 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $51.55 / $51.55 / $51.55
| Facility | 53 | $51.55 | $51.55 | $51.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.52 / $400.00 / $1,721.28
| Professional | | $164.52 | $400.00 | $1,721.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $470.00 / $1,429.00 / $4,010.00
| Facility | | $470.00 | $1,429.00 | $4,010.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.23 / $1,064.55 / $2,054.08
| Professional | | $230.23 | $1,064.55 | $2,054.08 |