- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $217.19 / $1,335.11 / $5,463.36
| Facility | | $217.19 | $1,335.11 | $5,463.36 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $2,307.03 / $2,307.03 / $2,307.03
| Facility | 22 | $2,307.03 | $2,307.03 | $2,307.03 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $42.28 / $91.99 / $154.61
| Facility | 52 | $42.28 | $91.99 | $154.61 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $16.91 / $35.32 / $59.38
| Facility | 53 | $16.91 | $35.32 | $59.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.56 / $232.41 / $504.39
| Professional | | $84.56 | $232.41 | $504.39 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $41.11 / $105.95 / $163.41
| Professional | 52 | $41.11 | $105.95 | $163.41 |
- Facility/Professional
- Professional
- Modifier
- 53
- Low / Median / High Price
- $16.44 / $42.38 / $65.70
| Professional | 53 | $16.44 | $42.38 | $65.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,529.00 / $2,479.00 / $5,250.00
| Facility | | $1,529.00 | $2,479.00 | $5,250.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.28 / $205.30 / $427.63
| Professional | | $97.28 | $205.30 | $427.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $399.11 / $423.40 / $516.54
| Facility | | $399.11 | $423.40 | $516.54 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $109.07 / $109.07 / $109.07
| Facility | 52 | $109.07 | $109.07 | $109.07 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $27.27 / $27.27 / $27.27
| Facility | 53 | $27.27 | $27.27 | $27.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.90 / $228.32 / $429.61
| Professional | | $110.90 | $228.32 | $429.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $956.50 / $1,785.50 / $3,981.00
| Facility | | $956.50 | $1,785.50 | $3,981.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $205.31 / $278.67 / $488.27
| Professional | | $205.31 | $278.67 | $488.27 |