- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $912.01 / $5,623.41
| Facility | | $316.23 | $912.01 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $309.03 / $331.13 / $524.81
| Facility | 52 | $309.03 | $331.13 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $398.11 / $812.83 / $1,659.59
| Facility | 54 | $398.11 | $812.83 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $363.08 / $776.25
| Professional | | $269.15 | $363.08 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $3,630.78 / $8,709.64
| Facility | | $1,445.44 | $3,630.78 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $371.54 / $724.44
| Professional | | $245.47 | $371.54 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $575.44 / $2,511.89
| Facility | | $295.12 | $575.44 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $416.87 / $416.87 / $416.87
| Facility | 52 | $416.87 | $416.87 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $363.08 / $363.08 / $363.08
| Facility | 54 | $363.08 | $363.08 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $436.52 / $954.99
| Professional | | $288.40 | $436.52 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $1,071.52 / $3,467.37
| Facility | | $204.17 | $1,071.52 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $346.74 / $676.08
| Professional | | $245.47 | $346.74 | $676.08 |