- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.30 / $2,649.57 / $7,119.04
| Facility | | $549.30 | $2,649.57 | $7,119.04 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $115.99 / $115.99 / $211.28
| Facility | 52 | $115.99 | $115.99 | $211.28 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $46.39 / $46.39 / $84.51
| Facility | 53 | $46.39 | $46.39 | $84.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.97 / $413.22 / $802.84
| Professional | | $231.97 | $413.22 | $802.84 |
- Facility/Professional
- Professional
- Modifier
- 53
- Low / Median / High Price
- $46.39 / $84.51 / $152.96
| Professional | 53 | $46.39 | $84.51 | $152.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $244.53 / $346.41 / $575.21
| Professional | | $244.53 | $346.41 | $575.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,665.88 / $3,864.78 / $6,782.44
| Facility | | $2,665.88 | $3,864.78 | $6,782.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $404.83 / $690.07 / $920.09
| Professional | | $404.83 | $690.07 | $920.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.84 / $843.65 / $1,251.13
| Professional | | $380.84 | $843.65 | $1,251.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $347.96 / $833.00 / $2,551.67
| Facility | | $347.96 | $833.00 | $2,551.67 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $909.50 / $909.50 / $909.50
| Facility | 52 | $909.50 | $909.50 | $909.50 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $227.37 / $227.37 / $227.37
| Facility | 53 | $227.37 | $227.37 | $227.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $474.23 / $812.14 / $1,906.00
| Professional | | $474.23 | $812.14 | $1,906.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $546.57 / $979.61 / $1,285.49
| Facility | | $546.57 | $979.61 | $1,285.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $546.57 / $843.65 / $1,247.68
| Professional | | $546.57 | $843.65 | $1,247.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.86 / $542.53 / $1,043.33
| Professional | | $243.86 | $542.53 | $1,043.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,679.00 / $3,167.00 / $7,772.00
| Facility | | $2,679.00 | $3,167.00 | $7,772.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $628.19 / $976.20 / $1,247.08
| Professional | | $628.19 | $976.20 | $1,247.08 |