- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $2,488.00 / $5,691.00
| Facility | | $346.74 | $2,488.00 | $5,691.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $92.96 / $121.37 / $517.12
| Facility | 52 | $92.96 | $121.37 | $517.12 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $37.18 / $48.55 / $206.85
| Facility | 53 | $37.18 | $48.55 | $206.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.50 / $654.77 / $1,063.13
| Professional | | $197.50 | $654.77 | $1,063.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $821.00 / $1,963.00 / $4,852.00
| Facility | | $821.00 | $1,963.00 | $4,852.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $217.79 / $639.27 / $1,323.77
| Professional | | $217.79 | $639.27 | $1,323.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $233.54 / $516.00 / $1,748.20
| Professional | | $233.54 | $516.00 | $1,748.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $185.92 / $901.78 / $3,006.00
| Facility | | $185.92 | $901.78 | $3,006.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $727.83 / $727.83 / $727.83
| Facility | 52 | $727.83 | $727.83 | $727.83 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $181.96 / $181.96 / $181.96
| Facility | 53 | $181.96 | $181.96 | $181.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $961.21 / $1,565.55 / $6,599.52
| Professional | | $961.21 | $1,565.55 | $6,599.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,438.00 / $2,874.00 / $5,813.00
| Facility | | $1,438.00 | $2,874.00 | $5,813.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $897.36 / $1,163.92 / $1,984.43
| Professional | | $897.36 | $1,163.92 | $1,984.43 |