- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $113.35 / $1,784.64 / $3,811.23
| Facility | | $113.35 | $1,784.64 | $3,811.23 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $56.68 / $141.41 / $141.41
| Facility | 52 | $56.68 | $141.41 | $141.41 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $22.67 / $56.57 / $56.57
| Facility | 53 | $22.67 | $56.57 | $56.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.35 / $233.94 / $645.71
| Professional | | $113.35 | $233.94 | $645.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,100.00 / $2,090.69 / $3,458.00
| Facility | | $1,100.00 | $2,090.69 | $3,458.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.67 / $450.49 / $982.02
| Professional | | $239.67 | $450.49 | $982.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $613.11 / $1,028.41 / $2,473.98
| Facility | | $613.11 | $1,028.41 | $2,473.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $256.44 / $513.80 / $1,219.83
| Professional | | $256.44 | $513.80 | $1,219.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $528.83 / $906.72 / $1,948.01
| Facility | | $528.83 | $906.72 | $1,948.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.90 / $481.44 / $1,059.53
| Professional | | $253.90 | $481.44 | $1,059.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $174.56 / $453.95 / $2,296.00
| Facility | | $174.56 | $453.95 | $2,296.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.35 / $564.79 / $1,305.72
| Professional | | $271.35 | $564.79 | $1,305.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,224.00 / $3,500.00 / $6,361.00
| Facility | | $1,224.00 | $3,500.00 | $6,361.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $289.02 / $564.77 / $1,124.46
| Professional | | $289.02 | $564.77 | $1,124.46 |