- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.74 / $2,750.54 / $5,011.58
| Facility | | $371.74 | $2,750.54 | $5,011.58 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $63.95 / $185.87 / $185.87
| Facility | 52 | $63.95 | $185.87 | $185.87 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $25.58 / $74.34 / $74.34
| Facility | 53 | $25.58 | $74.34 | $74.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.61 / $243.11 / $1,043.09
| Professional | | $101.61 | $243.11 | $1,043.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,037.93 / $1,848.06 / $3,458.00
| Facility | | $1,037.93 | $1,848.06 | $3,458.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.58 / $571.19 / $1,283.56
| Professional | | $269.58 | $571.19 | $1,283.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $803.24 / $1,347.32 / $3,241.17
| Facility | | $803.24 | $1,347.32 | $3,241.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $289.50 / $642.59 / $1,585.79
| Professional | | $289.50 | $642.59 | $1,585.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $692.82 / $1,187.90 / $2,552.10
| Facility | | $692.82 | $1,187.90 | $2,552.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $286.64 / $625.87 / $1,377.38
| Professional | | $286.64 | $625.87 | $1,377.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $228.96 / $1,070.84 / $2,699.25
| Facility | | $228.96 | $1,070.84 | $2,699.25 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $1,956.86 / $1,956.86 / $1,956.86
| Facility | 53 | $1,956.86 | $1,956.86 | $1,956.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.37 / $436.57 / $1,415.95
| Professional | | $153.37 | $436.57 | $1,415.95 |
- 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
- $380.23 / $752.30 / $1,480.81
| Professional | | $380.23 | $752.30 | $1,480.81 |