- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.84 / $260.72 / $3,812.04
| Facility | | $80.84 | $260.72 | $3,812.04 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $40.43 / $130.36 / $130.36
| Facility | 52 | $40.43 | $130.36 | $130.36 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $16.17 / $52.14 / $52.14
| Facility | 53 | $16.17 | $52.14 | $52.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.84 / $166.51 / $394.68
| Professional | | $80.84 | $166.51 | $394.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $927.29 / $1,718.03 / $3,221.46
| Facility | | $927.29 | $1,718.03 | $3,221.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.29 / $385.38 / $898.95
| Professional | | $172.29 | $385.38 | $898.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $563.26 / $944.80 / $2,272.84
| Facility | | $563.26 | $944.80 | $2,272.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.96 / $429.22 / $1,115.27
| Professional | | $182.96 | $429.22 | $1,115.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $485.83 / $833.00 / $1,789.64
| Facility | | $485.83 | $833.00 | $1,789.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.15 / $441.23 / $971.02
| Professional | | $181.15 | $441.23 | $971.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $117.15 / $264.13 / $756.63
| Facility | | $117.15 | $264.13 | $756.63 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $1,944.63 / $1,944.63 / $1,944.63
| Facility | 52 | $1,944.63 | $1,944.63 | $1,944.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $266.07 / $610.23 / $1,943.60
| Professional | | $266.07 | $610.23 | $1,943.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,224.00 / $3,500.00 / $6,361.00
| Facility | | $1,224.00 | $3,500.00 | $6,361.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.76 / $460.02 / $959.83
| Professional | | $225.76 | $460.02 | $959.83 |