- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $220.08 / $1,285.44 / $6,781.31
| Facility | | $220.08 | $1,285.44 | $6,781.31 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $38.72 / $110.04 / $316.66
| Facility | 52 | $38.72 | $110.04 | $316.66 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $15.49 / $44.02 / $126.66
| Facility | 53 | $15.49 | $44.02 | $126.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.30 / $233.40 / $875.13
| Professional | | $87.30 | $233.40 | $875.13 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $39.28 / $105.51 / $154.02
| Professional | 52 | $39.28 | $105.51 | $154.02 |
- Facility/Professional
- Professional
- Modifier
- 53
- Low / Median / High Price
- $15.71 / $42.20 / $61.61
| Professional | 53 | $15.71 | $42.20 | $61.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.21 / $251.21 / $251.21
| Professional | | $251.21 | $251.21 | $251.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $764.00 / $1,514.00 / $2,244.00
| Facility | | $764.00 | $1,514.00 | $2,244.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.78 / $186.07 / $358.39
| Professional | | $91.78 | $186.07 | $358.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.57 / $217.52 / $366.83
| Professional | | $92.57 | $217.52 | $366.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $388.79 / $407.55 / $12,000.00
| Facility | | $388.79 | $407.55 | $12,000.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $289.45 / $311.02 / $311.02
| Facility | 52 | $289.45 | $311.02 | $311.02 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $72.36 / $77.76 / $77.76
| Facility | 53 | $72.36 | $77.76 | $77.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $846.46 / $1,582.80 / $1,848.00
| Professional | | $846.46 | $1,582.80 | $1,848.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.00 / $1,456.00 / $2,886.00
| Facility | | $741.00 | $1,456.00 | $2,886.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.08 / $301.52 / $478.57
| Professional | | $197.08 | $301.52 | $478.57 |