- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,443.96 / $8,769.03 / $11,699.93
| Facility | | $1,443.96 | $8,769.03 | $11,699.93 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $127.34 / $315.85 / $1,779.81
| Facility | 52 | $127.34 | $315.85 | $1,779.81 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $50.93 / $126.34 / $711.92
| Facility | 53 | $50.93 | $126.34 | $711.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.72 / $415.16 / $2,717.00
| Professional | | $234.72 | $415.16 | $2,717.00 |
- Facility/Professional
- Professional
- Modifier
- 53
- Low / Median / High Price
- $45.25 / $126.34 / $288.79
| Professional | 53 | $45.25 | $126.34 | $288.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.57 / $199.57 / $199.57
| Professional | | $199.57 | $199.57 | $199.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,310.14 / $3,972.30 / $8,467.51
| Facility | | $1,310.14 | $3,972.30 | $8,467.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.55 / $568.00 / $1,337.80
| Professional | | $215.55 | $568.00 | $1,337.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,130.29 / $2,130.29 / $2,737.46
| Facility | | $2,130.29 | $2,130.29 | $2,737.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $291.58 / $447.55 / $2,546.39
| Professional | | $291.58 | $447.55 | $2,546.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $254.67 / $449.12 / $2,335.42
| Facility | | $254.67 | $449.12 | $2,335.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,034.70 / $1,884.79 / $2,096.12
| Professional | | $1,034.70 | $1,884.79 | $2,096.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,018.17 / $1,377.53 / $2,138.40
| Professional | | $1,018.17 | $1,377.53 | $2,138.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $791.00 / $10,257.00 / $16,249.00
| Facility | | $791.00 | $10,257.00 | $16,249.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $366.69 / $1,426.90 / $3,229.61
| Professional | | $366.69 | $1,426.90 | $3,229.61 |