- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,095.80 / $7,421.00 / $28,155.00
| Facility | | $1,095.80 | $7,421.00 | $28,155.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $302.58 / $302.58 / $349.43
| Facility | 52 | $302.58 | $302.58 | $349.43 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $121.03 / $121.03 / $9,759.00
| Facility | 53 | $121.03 | $121.03 | $9,759.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,258.84 / $10,793.60 / $25,198.09
| Facility | | $2,258.84 | $10,793.60 | $25,198.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,105.00 / $11,616.00 / $25,173.00
| Facility | | $8,105.00 | $11,616.00 | $25,173.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $763.97 / $891.30 / $3,516.00
| Professional | | $763.97 | $891.30 | $3,516.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,725.00 / $13,746.00 / $24,000.00
| Facility | | $2,725.00 | $13,746.00 | $24,000.00 |