- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $982.22 / $3,297.45 / $7,938.73
| Facility | | $982.22 | $3,297.45 | $7,938.73 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $97.95 / $293.67 / $1,809.16
| Facility | 52 | $97.95 | $293.67 | $1,809.16 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $39.18 / $117.47 / $723.66
| Facility | 53 | $39.18 | $117.47 | $723.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $237.38 / $413.98 / $1,858.11
| Professional | | $237.38 | $413.98 | $1,858.11 |
- Facility/Professional
- Professional
- Modifier
- 53
- Low / Median / High Price
- $39.18 / $241.37 / $356.69
| Professional | 53 | $39.18 | $241.37 | $356.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $320.97 / $320.97 / $1,468.22
| Professional | | $320.97 | $320.97 | $1,468.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,132.00 / $3,688.00 / $5,878.00
| Facility | | $2,132.00 | $3,688.00 | $5,878.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $248.65 / $475.52 / $2,340.92
| Professional | | $248.65 | $475.52 | $2,340.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.01 / $517.66 / $2,209.79
| Professional | | $255.01 | $517.66 | $2,209.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,131.86 / $2,294.04 / $26,542.00
| Facility | | $2,131.86 | $2,294.04 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $840.46 / $896.65 / $896.65
| Facility | 52 | $840.46 | $896.65 | $896.65 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $210.11 / $224.16 / $224.16
| Facility | 53 | $210.11 | $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 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,695.00 / $3,616.00 / $6,285.00
| Facility | | $1,695.00 | $3,616.00 | $6,285.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $373.83 / $1,386.62 / $2,706.50
| Professional | | $373.83 | $1,386.62 | $2,706.50 |