- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $1,479.11 / $6,456.54
| Facility | | $346.74 | $1,479.11 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $1,412.54 / $1,412.54 / $1,412.54
| Facility | 52 | $1,412.54 | $1,412.54 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $371.54 / $741.31
| Professional | | $181.97 | $371.54 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $109.65 / $173.78
| Professional | | $85.11 | $109.65 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $3,467.37 / $5,495.41
| Facility | | $2,187.76 | $3,467.37 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $426.58 / $588.84
| Professional | | $194.98 | $426.58 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $371.54 / $676.08
| Professional | | $223.87 | $371.54 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $478.63 / $2,754.23
| Facility | | $213.80 | $478.63 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $724.44 / $724.44 / $724.44
| Facility | 52 | $724.44 | $724.44 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $181.97 / $181.97 / $181.97
| Facility | 53 | $181.97 | $181.97 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $524.81 / $3,311.31
| Professional | | $371.54 | $524.81 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $1,949.84 / $3,467.37
| Facility | | $524.81 | $1,949.84 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $346.74 / $575.44
| Professional | | $186.21 | $346.74 | $575.44 |