- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,200.00 / $4,968.00 / $9,906.39
| Facility | | $1,200.00 | $4,968.00 | $9,906.39 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $134.54 / $166.91 / $967.51
| Facility | 52 | $134.54 | $166.91 | $967.51 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $53.82 / $66.76 / $387.00
| Facility | 53 | $53.82 | $66.76 | $387.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $224.23 / $333.82 / $1,760.37
| Professional | | $224.23 | $333.82 | $1,760.37 |
- Facility/Professional
- Professional
- Modifier
- 53
- Low / Median / High Price
- $44.85 / $242.96 / $387.00
| Professional | 53 | $44.85 | $242.96 | $387.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $238.81 / $238.81 / $238.81
| Professional | | $238.81 | $238.81 | $238.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,852.94 / $3,250.33 / $5,920.50
| Facility | | $1,852.94 | $3,250.33 | $5,920.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $350.16 / $350.16 / $1,591.75
| Professional | | $350.16 | $350.16 | $1,591.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,103.00 / $7,103.00 / $7,103.00
| Facility | | $7,103.00 | $7,103.00 | $7,103.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.32 / $557.46 / $2,344.34
| Professional | | $254.32 | $557.46 | $2,344.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $224.23 / $927.00 / $5,562.00
| Facility | | $224.23 | $927.00 | $5,562.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $364.81 / $1,858.36 / $9,714.64
| Professional | | $364.81 | $1,858.36 | $9,714.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,436.00 / $3,096.00 / $5,565.00
| Facility | | $1,436.00 | $3,096.00 | $5,565.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $364.81 / $1,429.51 / $2,903.43
| Professional | | $364.81 | $1,429.51 | $2,903.43 |