- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,910.95 / $7,535.00 / $9,799.73
| Facility | | $1,910.95 | $7,535.00 | $9,799.73 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $113.12 / $184.91 / $1,034.66
| Facility | 52 | $113.12 | $184.91 | $1,034.66 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $45.25 / $73.95 / $413.86
| Facility | 53 | $45.25 | $73.95 | $413.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.24 / $506.23 / $3,118.19
| Professional | | $226.24 | $506.23 | $3,118.19 |
- Facility/Professional
- Professional
- Modifier
- 53
- Low / Median / High Price
- $45.25 / $96.40 / $300.97
| Professional | 53 | $45.25 | $96.40 | $300.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.98 / $629.95 / $1,682.75
| Professional | | $338.98 | $629.95 | $1,682.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $320.69 / $486.74 / $2,786.55
| Professional | | $320.69 | $486.74 | $2,786.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $226.24 / $486.74 / $1,611.43
| Facility | | $226.24 | $486.74 | $1,611.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $429.04 / $429.04 / $3,497.43
| Professional | | $429.04 | $429.04 | $3,497.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,012.57 / $15,283.22 / $23,031.02
| Facility | | $8,012.57 | $15,283.22 | $23,031.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.00 / $439.20 / $3,819.70
| Professional | | $4.00 | $439.20 | $3,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,526.00 / $7,659.00 / $10,502.00
| Facility | | $2,526.00 | $7,659.00 | $10,502.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $361.06 / $1,269.15 / $3,615.28
| Professional | | $361.06 | $1,269.15 | $3,615.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,294.04 / $2,294.04 / $26,542.00
| Facility | | $2,294.04 | $2,294.04 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $896.65 / $896.65 / $896.65
| Facility | 52 | $896.65 | $896.65 | $896.65 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $224.16 / $224.16 / $224.16
| Facility | 53 | $224.16 | $224.16 | $224.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,713.31 / $8,969.32 / $10,538.93
| Professional | | $4,713.31 | $8,969.32 | $10,538.93 |