- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $442.05 / $2,001.90 / $3,570.56
| Facility | | $442.05 | $2,001.90 | $3,570.56 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $129.22 / $148.75 / $250.10
| Facility | 52 | $129.22 | $148.75 | $250.10 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $88.41 / $173.93 / $1,970.21
| Facility | 53 | $88.41 | $173.93 | $1,970.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.03 / $323.31 / $512.79
| Professional | | $187.03 | $323.31 | $512.79 |
- Facility/Professional
- Professional
- Modifier
- 53
- Low / Median / High Price
- $51.69 / $108.36 / $234.74
| Professional | 53 | $51.69 | $108.36 | $234.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $170.12 / $202.02 / $306.22
| Professional | | $170.12 | $202.02 | $306.22 |
- Facility/Professional
- Professional
- Modifier
- 53
- Low / Median / High Price
- $75.52 / $100.61 / $115.24
| Professional | 53 | $75.52 | $100.61 | $115.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $670.94 / $1,394.44 / $2,234.42
| Facility | | $670.94 | $1,394.44 | $2,234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.45 / $365.66 / $587.07
| Professional | | $239.45 | $365.66 | $587.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $161.86 / $791.54 / $791.54
| Facility | | $161.86 | $791.54 | $791.54 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $40.00 / $81.08 / $81.08
| Facility | 53 | $40.00 | $81.08 | $81.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $310.83 / $650.00 / $820.00
| Facility | | $310.83 | $650.00 | $820.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $248.66 / $248.66 / $248.66
| Facility | 52 | $248.66 | $248.66 | $248.66 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $62.17 / $62.17 / $62.17
| Facility | 53 | $62.17 | $62.17 | $62.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.33 / $340.46 / $606.65
| Professional | | $198.33 | $340.46 | $606.65 |
- Facility/Professional
- Professional
- Modifier
- 53
- Low / Median / High Price
- $143.54 / $215.03 / $267.63
| Professional | 53 | $143.54 | $215.03 | $267.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $470.00 / $1,179.00 / $3,130.00
| Facility | | $470.00 | $1,179.00 | $3,130.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $284.64 / $444.35 / $703.83
| Professional | | $284.64 | $444.35 | $703.83 |
- Facility/Professional
- Professional
- Modifier
- 53
- Low / Median / High Price
- $220.49 / $220.49 / $422.53
| Professional | 53 | $220.49 | $220.49 | $422.53 |