- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $491.25 / $2,529.65 / $6,151.25
| Facility | | $491.25 | $2,529.65 | $6,151.25 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $136.69 / $245.63 / $2,322.00
| Facility | 52 | $136.69 | $245.63 | $2,322.00 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $54.68 / $54.68 / $98.25
| Facility | 53 | $54.68 | $54.68 | $98.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $273.39 / $424.40 / $564.92
| Professional | | $273.39 | $424.40 | $564.92 |
- Facility/Professional
- Professional
- Modifier
- 53
- Low / Median / High Price
- $50.98 / $77.45 / $103.93
| Professional | 53 | $50.98 | $77.45 | $103.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.34 / $237.49 / $300.48
| Professional | | $210.34 | $237.49 | $300.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,353.71 / $3,681.34 / $5,743.62
| Facility | | $2,353.71 | $3,681.34 | $5,743.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.00 / $439.60 / $603.63
| Professional | | $245.00 | $439.60 | $603.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $280.42 / $457.66 / $680.26
| Professional | | $280.42 | $457.66 | $680.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $273.39 / $515.80 / $1,760.00
| Facility | | $273.39 | $515.80 | $1,760.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $909.50 / $909.50 / $909.50
| Facility | 52 | $909.50 | $909.50 | $909.50 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $227.37 / $227.37 / $227.37
| Facility | 53 | $227.37 | $227.37 | $227.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $388.67 / $632.64 / $3,439.23
| Professional | | $388.67 | $632.64 | $3,439.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.00 / $2,072.00 / $4,083.73
| Facility | | $575.00 | $2,072.00 | $4,083.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $388.67 / $524.44 / $738.08
| Professional | | $388.67 | $524.44 | $738.08 |