- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.30 / $2,357.04 / $5,581.88
| Facility | | $549.30 | $2,357.04 | $5,581.88 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $1,389.50 / $1,819.50 / $1,919.05
| Facility | 22 | $1,389.50 | $1,819.50 | $1,919.05 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $137.90 / $238.00 / $474.20
| Facility | 52 | $137.90 | $238.00 | $474.20 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $54.68 / $89.54 / $153.04
| Facility | 53 | $54.68 | $89.54 | $153.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.59 / $455.43 / $980.16
| Professional | | $255.59 | $455.43 | $980.16 |
- Facility/Professional
- Professional
- Modifier
- 53
- Low / Median / High Price
- $50.17 / $86.12 / $134.54
| Professional | 53 | $50.17 | $86.12 | $134.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,449.90 / $3,193.00 / $5,962.00
| Facility | | $1,449.90 | $3,193.00 | $5,962.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $277.10 / $430.69 / $684.29
| Professional | | $277.10 | $430.69 | $684.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $499.00 / $764.62 / $1,561.13
| Facility | | $499.00 | $764.62 | $1,561.13 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $341.33 / $341.33 / $341.33
| Facility | 52 | $341.33 | $341.33 | $341.33 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $85.33 / $85.33 / $85.33
| Facility | 53 | $85.33 | $85.33 | $85.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.38 / $511.04 / $962.68
| Professional | | $302.38 | $511.04 | $962.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $720.31 / $2,391.50 / $4,925.50
| Facility | | $720.31 | $2,391.50 | $4,925.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $419.86 / $611.20 / $1,051.99
| Professional | | $419.86 | $611.20 | $1,051.99 |