- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $483.86 / $2,122.17 / $5,503.00
| Facility | | $483.86 | $2,122.17 | $5,503.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $61.45 / $61.45 / $147.22
| Facility | 52 | $61.45 | $61.45 | $147.22 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $24.58 / $24.58 / $58.89
| Facility | 53 | $24.58 | $24.58 | $58.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.89 / $263.06 / $484.73
| Professional | | $122.89 | $263.06 | $484.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,974.00 / $2,866.00 / $7,022.00
| Facility | | $1,974.00 | $2,866.00 | $7,022.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.22 / $301.08 / $544.73
| Professional | | $147.22 | $301.08 | $544.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $206.39 / $600.00 / $1,652.00
| Facility | | $206.39 | $600.00 | $1,652.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $165.11 / $165.11 / $165.11
| Facility | 52 | $165.11 | $165.11 | $165.11 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $41.28 / $41.28 / $41.28
| Facility | 53 | $41.28 | $41.28 | $41.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.94 / $287.95 / $511.96
| Professional | | $153.94 | $287.95 | $511.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.49 / $287.82 / $463.06
| Facility | | $131.49 | $287.82 | $463.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.10 / $314.45 / $500.26
| Professional | | $155.10 | $314.45 | $500.26 |
- Facility/Professional
- Professional
- Modifier
- 53
- Low / Median / High Price
- $200.44 / $200.44 / $480.24
| Professional | 53 | $200.44 | $200.44 | $480.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,330.00 / $1,940.00 / $5,513.00
| Facility | | $1,330.00 | $1,940.00 | $5,513.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $304.30 / $425.71 / $832.46
| Professional | | $304.30 | $425.71 | $832.46 |