- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $2,454.71 / $7,244.36
| Facility | | $512.86 | $2,454.71 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $1,258.93 / $11,748.98 / $11,748.98
| Facility | 22 | $1,258.93 | $11,748.98 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $758.58 / $1,905.46 / $3,715.35
| Facility | 52 | $758.58 | $1,905.46 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $2,238.72 / $2,238.72 / $2,238.72
| Facility | 53 | $2,238.72 | $2,238.72 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.61 / $257.04 / $870.96
| Professional | | $67.61 | $257.04 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $4,073.80 / $9,332.54
| Facility | | $1,479.11 | $4,073.80 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $346.74 / $676.08
| Professional | | $162.18 | $346.74 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $812.83 / $3,388.44
| Facility | | $234.42 | $812.83 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $275.42 / $275.42 / $275.42
| Facility | 22 | $275.42 | $275.42 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $186.21 / $186.21 / $186.21
| Facility | 52 | $186.21 | $186.21 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $46.77 / $46.77 / $46.77
| Facility | 53 | $46.77 | $46.77 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $363.08 / $776.25
| Professional | | $158.49 | $363.08 | $776.25 |
- 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
- $134.90 / $309.03 / $616.60
| Professional | | $134.90 | $309.03 | $616.60 |