- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,014.91 / $6,781.00 / $11,537.50
| Facility | | $1,014.91 | $6,781.00 | $11,537.50 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $298.51 / $298.51 / $298.51
| Facility | 52 | $298.51 | $298.51 | $298.51 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $119.40 / $119.40 / $119.40
| Facility | 53 | $119.40 | $119.40 | $119.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $597.01 / $961.96 / $4,576.14
| Professional | | $597.01 | $961.96 | $4,576.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,056.92 / $9,837.79 / $20,505.30
| Facility | | $3,056.92 | $9,837.79 | $20,505.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,138.45 / $1,926.71 / $2,336.82
| Professional | | $1,138.45 | $1,926.71 | $2,336.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,395.91 / $2,178.65 / $5,241.04
| Facility | | $1,395.91 | $2,178.65 | $5,241.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,112.25 / $1,986.75 / $2,731.54
| Professional | | $1,112.25 | $1,986.75 | $2,731.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,209.68 / $1,988.16 / $4,126.80
| Facility | | $1,209.68 | $1,988.16 | $4,126.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,101.24 / $1,812.58 / $2,497.42
| Professional | | $1,101.24 | $1,812.58 | $2,497.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $880.24 / $3,540.25 / $10,575.50
| Facility | | $880.24 | $3,540.25 | $10,575.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $761.82 / $1,529.38 / $4,971.47
| Professional | | $761.82 | $1,529.38 | $4,971.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,437.00 / $9,370.00 / $12,774.00
| Facility | | $3,437.00 | $9,370.00 | $12,774.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $692.56 / $1,385.12 / $2,595.96
| Professional | | $692.56 | $1,385.12 | $2,595.96 |