- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $492.18 / $2,015.01 / $6,070.12
| Facility | | $492.18 | $2,015.01 | $6,070.12 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $157.44 / $283.83 / $4,833.10
| Facility | 52 | $157.44 | $283.83 | $4,833.10 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $62.98 / $84.88 / $153.04
| Facility | 53 | $62.98 | $84.88 | $153.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $262.42 / $440.86 / $765.20
| Professional | | $262.42 | $440.86 | $765.20 |
- Facility/Professional
- Professional
- Modifier
- 53
- Low / Median / High Price
- $52.48 / $88.77 / $153.04
| Professional | 53 | $52.48 | $88.77 | $153.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.89 / $237.69 / $275.95
| Professional | | $206.89 | $237.69 | $275.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,074.17 / $1,483.01 / $2,514.55
| Facility | | $1,074.17 | $1,483.01 | $2,514.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $586.36 / $586.36 / $813.00
| Professional | | $586.36 | $586.36 | $813.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $744.00 / $800.00 / $2,437.00
| Facility | | $744.00 | $800.00 | $2,437.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $285.76 / $496.63 / $825.00
| Professional | | $285.76 | $496.63 | $825.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $273.02 / $568.15 / $1,450.00
| Facility | | $273.02 | $568.15 | $1,450.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.26 / $718.29 / $3,439.23
| Professional | | $457.26 | $718.29 | $3,439.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $733.62 / $1,450.00 / $3,918.00
| Facility | | $733.62 | $1,450.00 | $3,918.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $433.55 / $578.38 / $891.66
| Professional | | $433.55 | $578.38 | $891.66 |