- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $1,905.46 / $7,244.36
| Facility | | $338.84 | $1,905.46 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $1,288.25 / $1,288.25 / $1,288.25
| Facility | 22 | $1,288.25 | $1,288.25 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $1.78 / $1,412.54 / $2,454.71
| Facility | 52 | $1.78 | $1,412.54 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $407.38 / $870.96
| Professional | | $181.97 | $407.38 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $3,890.45 / $9,549.93
| Facility | | $1,513.56 | $3,890.45 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $363.08 / $660.69
| Professional | | $213.80 | $363.08 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $741.31 / $2,344.23
| Facility | | $338.84 | $741.31 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $407.38 / $407.38 / $407.38
| Facility | 22 | $407.38 | $407.38 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $269.15 / $269.15 / $269.15
| Facility | 52 | $269.15 | $269.15 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $67.61 / $67.61 / $67.61
| Facility | 53 | $67.61 | $67.61 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $446.68 / $933.25
| Professional | | $223.87 | $446.68 | $933.25 |
- 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
- $194.98 / $389.05 / $741.31
| Professional | | $194.98 | $389.05 | $741.31 |