- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $585.25 / $2,683.00 / $7,493.26
| Facility | | $585.25 | $2,683.00 | $7,493.26 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $737.18 / $4,595.89 / $4,595.89
| Facility | 50 | $737.18 | $4,595.89 | $4,595.89 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $145.25 / $200.78 / $412.82
| Facility | 52 | $145.25 | $200.78 | $412.82 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $58.10 / $80.31 / $165.13
| Facility | 53 | $58.10 | $80.31 | $165.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $301.58 / $373.08 / $840.41
| Professional | | $301.58 | $373.08 | $840.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,132.00 / $3,728.00 / $5,774.00
| Facility | | $2,132.00 | $3,728.00 | $5,774.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $286.14 / $386.54 / $680.67
| Professional | | $286.14 | $386.54 | $680.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $304.77 / $427.36 / $660.74
| Professional | | $304.77 | $427.36 | $660.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,103.52 / $9,388.90 / $26,542.00
| Facility | | $1,103.52 | $9,388.90 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $613.42 / $7,119.48 / $7,119.48
| Facility | 52 | $613.42 | $7,119.48 | $7,119.48 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $153.36 / $1,779.87 / $1,779.87
| Facility | 53 | $153.36 | $1,779.87 | $1,779.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,853.12 / $2,853.12 / $2,853.12
| Professional | | $2,853.12 | $2,853.12 | $2,853.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,695.00 / $3,616.00 / $6,285.00
| Facility | | $1,695.00 | $3,616.00 | $6,285.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $294.38 / $455.60 / $714.84
| Professional | | $294.38 | $455.60 | $714.84 |