- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $103.49 / $1,100.00 / $3,500.00
| Facility | | $103.49 | $1,100.00 | $3,500.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $49.31 / $56.59 / $200.27
| Facility | 52 | $49.31 | $56.59 | $200.27 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $19.72 / $22.63 / $80.11
| Facility | 53 | $19.72 | $22.63 | $80.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.84 / $157.77 / $390.00
| Professional | | $71.84 | $157.77 | $390.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.71 / $76.09 / $83.47
| Professional | | $62.71 | $76.09 | $83.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.27 / $1,091.72 / $1,794.05
| Facility | | $616.27 | $1,091.72 | $1,794.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.16 / $137.71 / $436.29
| Professional | | $95.16 | $137.71 | $436.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $65.40 / $486.07 / $486.07
| Facility | | $65.40 | $486.07 | $486.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $121.96 / $525.00 / $678.19
| Facility | | $121.96 | $525.00 | $678.19 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $97.57 / $97.57 / $97.57
| Facility | 52 | $97.57 | $97.57 | $97.57 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $24.39 / $24.39 / $24.39
| Facility | 53 | $24.39 | $24.39 | $24.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.26 / $200.00 / $446.46
| Professional | | $77.26 | $200.00 | $446.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $334.00 / $1,049.00 / $2,271.00
| Facility | | $334.00 | $1,049.00 | $2,271.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.57 / $271.91 / $523.60
| Professional | | $197.57 | $271.91 | $523.60 |