- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.73 / $2,557.00 / $6,001.70
| Facility | | $537.73 | $2,557.00 | $6,001.70 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $2,842.40 / $2,842.40 / $5,866.00
| Facility | 22 | $2,842.40 | $2,842.40 | $5,866.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $114.49 / $235.02 / $582.65
| Facility | 52 | $114.49 | $235.02 | $582.65 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $42.99 / $79.68 / $140.81
| Facility | 53 | $42.99 | $79.68 | $140.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.54 / $429.79 / $950.04
| Professional | | $200.54 | $429.79 | $950.04 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $99.14 / $202.69 / $336.38
| Professional | 52 | $99.14 | $202.69 | $336.38 |
- Facility/Professional
- Professional
- Modifier
- 53
- Low / Median / High Price
- $39.54 / $80.11 / $124.96
| Professional | 53 | $39.54 | $80.11 | $124.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,449.90 / $3,193.00 / $5,709.85
| Facility | | $1,449.90 | $3,193.00 | $5,709.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.20 / $358.77 / $559.82
| Professional | | $219.20 | $358.77 | $559.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $473.50 / $762.60 / $1,561.13
| Facility | | $473.50 | $762.60 | $1,561.13 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $270.52 / $270.52 / $270.52
| Facility | 52 | $270.52 | $270.52 | $270.52 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $67.63 / $67.63 / $67.63
| Facility | 53 | $67.63 | $67.63 | $67.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $247.19 / $457.55 / $888.09
| Professional | | $247.19 | $457.55 | $888.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $811.50 / $2,302.00 / $5,253.50
| Facility | | $811.50 | $2,302.00 | $5,253.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $384.16 / $559.66 / $979.22
| Professional | | $384.16 | $559.66 | $979.22 |