- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $2,238.72 / $6,760.83
| Facility | | $218.78 | $2,238.72 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $407.38 / $1,288.25 / $3,467.37
| Facility | 52 | $407.38 | $1,288.25 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.18 / $177.83 / $602.56
| Professional | | $69.18 | $177.83 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $3,548.13 / $8,709.64
| Facility | | $1,348.96 | $3,548.13 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $162.18 / $436.52
| Professional | | $70.79 | $162.18 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.03 / $645.65 / $2,187.76
| Facility | | $123.03 | $645.65 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $97.72 / $97.72 / $97.72
| Facility | 52 | $97.72 | $97.72 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $24.55 / $24.55 / $24.55
| Facility | 53 | $24.55 | $24.55 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $204.17 / $575.44
| Professional | | $79.43 | $204.17 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $1,778.28 / $4,570.88
| Facility | | $446.68 | $1,778.28 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.61 / $165.96 / $416.87
| Professional | | $67.61 | $165.96 | $416.87 |