- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $507.18 / $1,560.00 / $5,657.51
| Facility | | $507.18 | $1,560.00 | $5,657.51 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $92.07 / $92.07 / $173.63
| Facility | 52 | $92.07 | $92.07 | $173.63 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $74.34 / $160.58 / $274.98
| Facility | 53 | $74.34 | $160.58 | $274.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.13 / $347.26 / $681.50
| Professional | | $184.13 | $347.26 | $681.50 |
- Facility/Professional
- Professional
- Modifier
- 53
- Low / Median / High Price
- $40.72 / $92.38 / $215.99
| Professional | 53 | $40.72 | $92.38 | $215.99 |
- 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
- $205.86 / $267.32 / $386.24
| Professional | | $205.86 | $267.32 | $386.24 |
- Facility/Professional
- Professional
- Modifier
- 53
- Low / Median / High Price
- $74.84 / $169.43 / $226.25
| Professional | 53 | $74.84 | $169.43 | $226.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $310.83 / $800.00 / $2,213.00
| Facility | | $310.83 | $800.00 | $2,213.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $248.66 / $248.66 / $248.66
| Facility | 52 | $248.66 | $248.66 | $248.66 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $62.17 / $62.17 / $62.17
| Facility | 53 | $62.17 | $62.17 | $62.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $232.41 / $366.43 / $607.51
| Professional | | $232.41 | $366.43 | $607.51 |
- Facility/Professional
- Professional
- Modifier
- 53
- Low / Median / High Price
- $75.09 / $267.63 / $751.42
| Professional | 53 | $75.09 | $267.63 | $751.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.55 / $347.26 / $576.16
| Facility | | $199.55 | $347.26 | $576.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $232.39 / $393.27 / $667.56
| Professional | | $232.39 | $393.27 | $667.56 |
- Facility/Professional
- Professional
- Modifier
- 53
- Low / Median / High Price
- $116.60 / $194.02 / $312.11
| Professional | 53 | $116.60 | $194.02 | $312.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,463.00 / $2,155.00 / $5,513.00
| Facility | | $1,463.00 | $2,155.00 | $5,513.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $349.81 / $513.44 / $828.95
| Professional | | $349.81 | $513.44 | $828.95 |
- Facility/Professional
- Professional
- Modifier
- 53
- Low / Median / High Price
- $220.49 / $267.31 / $267.31
| Professional | 53 | $220.49 | $267.31 | $267.31 |