- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $594.15 / $2,361.00 / $6,068.00
| Facility | | $594.15 | $2,361.00 | $6,068.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $82.21 / $82.21 / $587.91
| Facility | 52 | $82.21 | $82.21 | $587.91 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $32.88 / $32.88 / $235.17
| Facility | 53 | $32.88 | $32.88 | $235.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.18 / $198.40 / $1,248.26
| Professional | | $156.18 | $198.40 | $1,248.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.26 / $167.63 / $227.07
| Professional | | $139.26 | $167.63 | $227.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,971.35 / $4,647.35 / $7,250.81
| Facility | | $2,971.35 | $4,647.35 | $7,250.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.05 / $1,072.40 / $1,472.56
| Professional | | $148.05 | $1,072.40 | $1,472.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.45 / $258.41 / $1,500.16
| Professional | | $176.45 | $258.41 | $1,500.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $164.41 / $748.15 / $2,598.00
| Facility | | $164.41 | $748.15 | $2,598.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $551.04 / $551.04 / $551.04
| Facility | 52 | $551.04 | $551.04 | $551.04 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $137.76 / $137.76 / $137.76
| Facility | 53 | $137.76 | $137.76 | $137.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.80 / $1,232.64 / $7,882.64
| Professional | | $192.80 | $1,232.64 | $7,882.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $498.00 / $1,760.00 / $4,012.00
| Facility | | $498.00 | $1,760.00 | $4,012.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.74 / $1,064.55 / $1,783.07
| Professional | | $182.74 | $1,064.55 | $1,783.07 |