- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $829.50 / $5,029.05 / $9,547.43
| Facility | | $829.50 | $5,029.05 | $9,547.43 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $8,008.02 / $8,008.02 / $8,008.02
| Facility | 22 | $8,008.02 | $8,008.02 | $8,008.02 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $117.77 / $189.25 / $880.19
| Facility | 52 | $117.77 | $189.25 | $880.19 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $46.27 / $73.79 / $304.02
| Facility | 53 | $46.27 | $73.79 | $304.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.72 / $404.72 / $1,792.27
| Professional | | $234.72 | $404.72 | $1,792.27 |
- Facility/Professional
- Professional
- Modifier
- 53
- Low / Median / High Price
- $45.17 / $90.60 / $316.68
| Professional | 53 | $45.17 | $90.60 | $316.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,448.00 / $4,757.00 / $8,800.00
| Facility | | $2,448.00 | $4,757.00 | $8,800.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $261.35 / $498.73 / $2,009.10
| Professional | | $261.35 | $498.73 | $2,009.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.04 / $2,792.04 / $4,261.84
| Facility | | $2,187.04 | $2,792.04 | $4,261.84 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $315.43 / $315.43 / $315.43
| Facility | 52 | $315.43 | $315.43 | $315.43 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $78.86 / $78.86 / $78.86
| Facility | 53 | $78.86 | $78.86 | $78.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $287.89 / $492.76 / $2,424.94
| Professional | | $287.89 | $492.76 | $2,424.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,981.00 / $4,383.00 / $7,934.00
| Facility | | $1,981.00 | $4,383.00 | $7,934.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $378.43 / $1,465.58 / $2,911.14
| Professional | | $378.43 | $1,465.58 | $2,911.14 |