- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $2,137.96 / $6,025.60
| Facility | | $346.74 | $2,137.96 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $549.54 / $1,445.44 / $3,311.31
| Facility | 52 | $549.54 | $1,445.44 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $1,288.25 / $2,398.83 / $3,801.89
| Facility | 53 | $1,288.25 | $2,398.83 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $251.19 / $691.83
| Professional | | $112.20 | $251.19 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $4,073.80 / $9,332.54
| Facility | | $1,412.54 | $4,073.80 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $288.40 / $549.54
| Professional | | $141.25 | $288.40 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $602.56 / $2,570.40
| Facility | | $204.17 | $602.56 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $245.47 / $245.47 / $245.47
| Facility | 22 | $245.47 | $245.47 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $165.96 / $165.96 / $165.96
| Facility | 52 | $165.96 | $165.96 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $41.69 / $41.69 / $41.69
| Facility | 53 | $41.69 | $41.69 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $295.12 / $616.60
| Professional | | $138.04 | $295.12 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $2,511.89 / $6,025.60
| Facility | | $645.65 | $2,511.89 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $251.19 / $489.78
| Professional | | $117.49 | $251.19 | $489.78 |