- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $384.35 / $2,676.28 / $6,097.00
| Facility | | $384.35 | $2,676.28 | $6,097.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $89.38 / $101.90 / $192.18
| Facility | 52 | $89.38 | $101.90 | $192.18 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $40.76 / $101.94 / $192.02
| Facility | 53 | $40.76 | $101.94 | $192.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.23 / $303.11 / $580.36
| Professional | | $175.23 | $303.11 | $580.36 |
- Facility/Professional
- Professional
- Modifier
- 53
- Low / Median / High Price
- $38.01 / $78.45 / $192.02
| Professional | 53 | $38.01 | $78.45 | $192.02 |
- 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
- $220.71 / $376.30 / $644.54
| Professional | | $220.71 | $376.30 | $644.54 |
- Facility/Professional
- Professional
- Modifier
- 53
- Low / Median / High Price
- $119.93 / $222.41 / $427.81
| Professional | 53 | $119.93 | $222.41 | $427.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $243.26 / $800.00 / $2,213.00
| Facility | | $243.26 | $800.00 | $2,213.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $194.61 / $194.61 / $194.61
| Facility | 52 | $194.61 | $194.61 | $194.61 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $48.65 / $48.65 / $48.65
| Facility | 53 | $48.65 | $48.65 | $48.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $301.45 / $301.45 / $301.45
| Professional | | $301.45 | $301.45 | $301.45 |
- Facility/Professional
- Professional
- Modifier
- 53
- Low / Median / High Price
- $75.09 / $143.83 / $267.63
| Professional | 53 | $75.09 | $143.83 | $267.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $203.79 / $345.92 / $576.16
| Facility | | $203.79 | $345.92 | $576.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $232.39 / $387.72 / $625.66
| Professional | | $232.39 | $387.72 | $625.66 |
- Facility/Professional
- Professional
- Modifier
- 53
- Low / Median / High Price
- $116.25 / $193.71 / $308.25
| Professional | 53 | $116.25 | $193.71 | $308.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,261.00 / $2,537.00 / $3,681.00
| Facility | | $1,261.00 | $2,537.00 | $3,681.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $366.99 / $520.45 / $809.25
| Professional | | $366.99 | $520.45 | $809.25 |
- Facility/Professional
- Professional
- Modifier
- 53
- Low / Median / High Price
- $204.61 / $204.61 / $204.61
| Professional | 53 | $204.61 | $204.61 | $204.61 |