- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $569.90 / $1,268.00 / $2,639.00
| Facility | | $569.90 | $1,268.00 | $2,639.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $284.95 / $284.95 / $284.95
| Facility | 52 | $284.95 | $284.95 | $284.95 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $113.98 / $113.98 / $113.98
| Facility | 53 | $113.98 | $113.98 | $113.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $290.49 / $569.91 / $769.37
| Professional | | $290.49 | $569.91 | $769.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,077.55 / $2,521.19 / $3,391.83
| Facility | | $2,077.55 | $2,521.19 | $3,391.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $349.67 / $479.00 / $565.22
| Professional | | $349.67 | $479.00 | $565.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $274.31 / $389.99 / $939.71
| Professional | | $274.31 | $389.99 | $939.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $834.00 / $2,891.00 / $4,402.00
| Facility | | $834.00 | $2,891.00 | $4,402.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.69 / $326.51 / $484.17
| Professional | | $231.69 | $326.51 | $484.17 |