- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $964.91 / $4,321.81 / $8,859.57
| Facility | | $964.91 | $4,321.81 | $8,859.57 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $102.95 / $648.41 / $648.41
| Facility | 52 | $102.95 | $648.41 | $648.41 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $41.18 / $259.37 / $259.37
| Facility | 53 | $41.18 | $259.37 | $259.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $205.89 / $368.93 / $1,876.35
| Professional | | $205.89 | $368.93 | $1,876.35 |
- Facility/Professional
- Professional
- Modifier
- 53
- Low / Median / High Price
- $41.18 / $242.96 / $325.17
| Professional | 53 | $41.18 | $242.96 | $325.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,816.14 / $6,373.77 / $11,110.48
| Facility | | $2,816.14 | $6,373.77 | $11,110.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $418.47 / $1,530.03 / $4,500.42
| Professional | | $418.47 | $1,530.03 | $4,500.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,362.32 / $4,768.18 / $11,470.51
| Facility | | $3,362.32 | $4,768.18 | $11,470.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $553.16 / $1,872.19 / $5,413.97
| Professional | | $553.16 | $1,872.19 | $5,413.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,733.32 / $4,359.26 / $9,031.90
| Facility | | $2,733.32 | $4,359.26 | $9,031.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $472.15 / $1,518.72 / $4,703.75
| Professional | | $472.15 | $1,518.72 | $4,703.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $393.70 / $2,434.66 / $6,571.54
| Facility | | $393.70 | $2,434.66 | $6,571.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,805.96 / $3,960.35 / $7,613.31
| Professional | | $1,805.96 | $3,960.35 | $7,613.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,735.00 / $4,974.00 / $8,812.00
| Facility | | $2,735.00 | $4,974.00 | $8,812.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,528.12 / $3,059.63 / $5,746.37
| Professional | | $1,528.12 | $3,059.63 | $5,746.37 |