- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $322.99 / $3,588.88 / $13,841.56
| Facility | | $322.99 | $3,588.88 | $13,841.56 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $50.82 / $50.82 / $147.97
| Facility | 52 | $50.82 | $50.82 | $147.97 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $20.32 / $20.32 / $59.19
| Facility | 53 | $20.32 | $20.32 | $59.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.14 / $230.31 / $648.66
| Professional | | $97.14 | $230.31 | $648.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,064.08 / $4,152.62 / $7,795.52
| Facility | | $3,064.08 | $4,152.62 | $7,795.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.91 / $240.69 / $590.75
| Professional | | $105.91 | $240.69 | $590.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.96 / $581.95 / $866.37
| Professional | | $239.96 | $581.95 | $866.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $152.46 / $517.90 / $1,584.35
| Facility | | $152.46 | $517.90 | $1,584.35 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $388.74 / $388.74 / $388.74
| Facility | 52 | $388.74 | $388.74 | $388.74 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $97.18 / $97.18 / $97.18
| Facility | 53 | $97.18 | $97.18 | $97.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $404.96 / $726.88 / $1,853.05
| Professional | | $404.96 | $726.88 | $1,853.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $264.73 / $581.95 / $852.71
| Facility | | $264.73 | $581.95 | $852.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $233.62 / $570.57 / $866.37
| Professional | | $233.62 | $570.57 | $866.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.00 / $231.00 / $1,479.60
| Professional | | $4.00 | $231.00 | $1,479.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,775.00 / $3,227.00 / $6,169.00
| Facility | | $1,775.00 | $3,227.00 | $6,169.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $466.88 / $690.55 / $794.32
| Professional | | $466.88 | $690.55 | $794.32 |