- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.65 / $2,943.72 / $4,248.39
| Facility | | $141.65 | $2,943.72 | $4,248.39 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $70.83 / $542.94 / $542.94
| Facility | 52 | $70.83 | $542.94 | $542.94 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $28.33 / $217.18 / $217.18
| Facility | 53 | $28.33 | $217.18 | $217.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.65 / $255.27 / $1,820.02
| Professional | | $141.65 | $255.27 | $1,820.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.39 / $3,244.31 / $7,260.00
| Facility | | $851.39 | $3,244.31 | $7,260.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $298.77 / $1,080.52 / $3,645.85
| Professional | | $298.77 | $1,080.52 | $3,645.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,489.52 / $3,885.50 / $9,347.09
| Facility | | $2,489.52 | $3,885.50 | $9,347.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $319.63 / $1,028.11 / $4,461.72
| Professional | | $319.63 | $1,028.11 | $4,461.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,997.99 / $3,425.73 / $7,359.91
| Facility | | $1,997.99 | $3,425.73 | $7,359.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.45 / $1,017.94 / $3,875.37
| Professional | | $316.45 | $1,017.94 | $3,875.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.04 / $991.67 / $3,034.02
| Facility | | $204.04 | $991.67 | $3,034.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $344.31 / $2,055.54 / $4,523.77
| Professional | | $344.31 | $2,055.54 | $4,523.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,224.00 / $3,500.00 / $6,361.00
| Facility | | $1,224.00 | $3,500.00 | $6,361.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,064.55 / $2,197.46 / $4,325.43
| Professional | | $1,064.55 | $2,197.46 | $4,325.43 |