- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $84.69 / $2,000.00 / $6,195.45
| Facility | | $84.69 | $2,000.00 | $6,195.45 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $42.35 / $42.35 / $107.67
| Facility | 52 | $42.35 | $42.35 | $107.67 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $16.94 / $16.94 / $43.07
| Facility | 53 | $16.94 | $16.94 | $43.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.69 / $214.15 / $833.70
| Professional | | $84.69 | $214.15 | $833.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.72 / $306.01 / $481.15
| Professional | | $163.72 | $306.01 | $481.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.53 / $261.11 / $552.46
| Professional | | $118.53 | $261.11 | $552.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $84.69 / $215.34 / $646.02
| Facility | | $84.69 | $215.34 | $646.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $256.95 / $438.62 / $563.30
| Professional | | $256.95 | $438.62 | $563.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.50 / $420.46 / $563.30
| Professional | | $218.50 | $420.46 | $563.30 |