- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $306.30 / $1,896.22 / $3,638.00
| Facility | | $306.30 | $1,896.22 | $3,638.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $153.15 / $153.15 / $153.15
| Facility | 52 | $153.15 | $153.15 | $153.15 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $61.26 / $61.26 / $61.26
| Facility | 53 | $61.26 | $61.26 | $61.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.30 / $472.50 / $798.53
| Professional | | $306.30 | $472.50 | $798.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,458.11 / $4,551.30 / $9,978.29
| Facility | | $1,458.11 | $4,551.30 | $9,978.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $556.16 / $944.74 / $1,148.46
| Professional | | $556.16 | $944.74 | $1,148.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $717.09 / $1,119.19 / $2,692.35
| Facility | | $717.09 | $1,119.19 | $2,692.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $586.80 / $1,024.48 / $1,438.45
| Professional | | $586.80 | $1,024.48 | $1,438.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $621.41 / $1,021.33 / $2,119.96
| Facility | | $621.41 | $1,021.33 | $2,119.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $561.39 / $924.02 / $1,273.15
| Professional | | $561.39 | $924.02 | $1,273.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $334.39 / $669.43 / $2,839.00
| Facility | | $334.39 | $669.43 | $2,839.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $412.37 / $871.11 / $2,445.36
| Professional | | $412.37 | $871.11 | $2,445.36 |
- 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
- $366.73 / $677.28 / $1,315.59
| Professional | | $366.73 | $677.28 | $1,315.59 |