- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $384.10 / $4,318.83 / $8,500.00
| Facility | | $384.10 | $4,318.83 | $8,500.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $115.68 / $115.68 / $708.81
| Facility | 52 | $115.68 | $115.68 | $708.81 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $46.27 / $46.27 / $283.52
| Facility | 53 | $46.27 | $46.27 | $283.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.39 / $323.77 / $1,417.61
| Professional | | $213.39 | $323.77 | $1,417.61 |
- Facility/Professional
- Professional
- Modifier
- 53
- Low / Median / High Price
- $41.18 / $259.37 / $283.52
| Professional | 53 | $41.18 | $259.37 | $283.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $456.32 / $1,836.09 / $3,165.18
| Professional | | $456.32 | $1,836.09 | $3,165.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $367.59 / $1,898.06 / $3,969.49
| Professional | | $367.59 | $1,898.06 | $3,969.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $231.35 / $1,864.46 / $4,052.00
| Facility | | $231.35 | $1,864.46 | $4,052.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,429.51 / $2,600.61 / $3,726.88
| Professional | | $1,429.51 | $2,600.61 | $3,726.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,429.51 / $2,600.61 / $3,726.88
| Professional | | $1,429.51 | $2,600.61 | $3,726.88 |